跟腱断裂修补术后再断裂与感染的发病率、危险因素及临床预后

目的:探讨跟腱断裂修补术后再断裂与感染的发病率、危险因素及临床预后。方法:回顾性研究1994年1月至2008年12月在我所行跟腱断裂修补术后发生再断裂和(或)感染的患者,记录其性别、年龄、职业、生活习惯、内科合并症、受伤机制、断裂及手术时间、断裂形态、治疗方式、术后康复等数据,分析总结跟腱再断裂与感染的发病率、危险因素与临床预后。结果:跟腱断裂行修补手术共计916例,术后发生跟腱再断裂和(或)感染28例(其中4例再断裂合并感染),再断率2.3%(21例),感染率1.2%(11例)。跟腱再断裂多发生于运动员或戏剧演员;跟腱感染多见于高龄,合并糖尿病、高脂血症,跟腱炎、局部激素治疗以及断裂后治疗延迟(>14天)的患者。术后随访16例(9例再断裂,5例感染,2例再断裂合并感染),平均随访49.4个月(12～124个月),优良率87.5%。其中3年以上患者全部为优,结果明显好于1～3年的患者(P=0.019),感染组预后略差于再断组。结论:跟腱术后再断裂和感染是跟腱断裂修补术后的两大常见且严重的并发症。从事运动或戏剧表演职业的患者易于发生跟腱术后再断裂,而高龄、高脂血症、跟腱炎、激素治疗史,及伤后延迟治疗等是跟腱术后感染的高危险因素。治疗得当,长期(3年以上)临床预后较好;跟腱感染患者预后略差于跟腱再断裂患者。

The Incidence, Risk Factors and Clinical Outcome of Rerupture and Deep Infection Following Operation of Achilles Tendon Rupture

Objective To study the incidence,risk factors and clinical outcome of rerupture and infection after Achilles tendon repair. Methods From January 1994 to December 2008, 916 patients with Achilles tendon rupture who undertook surgical repair were retrospectively reviewed and the incidence as well as the risk factors of rerupture were analyzed. Results Twenty-one rerupture (2.3%)and eleven deep infection (1.2%)occurred in twenty-eight patients. Athletes were prone to rerupture. Deep infections were more often seen in patients who were older,had concomitant diseases such as diabetes and hyperlipemia,had sustained the tendon diseases,had received corticosteroid medication more often,and had a longer delay before treatment. Sixteen patients had a 49.4 months (12 to 124 months) follow-up,and 87.5% patients were excellent and good. The outcome increased significantly after three years (P =0.019). Conclusions Rerupture and deep infection following Achilles tendon repair were the most common severe complications. Age,diabetes,hyperlipemia,corticosteroid use,previous symptoms in the Achilles tendon area,and delayed treatment of Achilles tendon rupture were risk factor of deep infection.