塑型卵圆钳经皮缝合与切开缝合治疗新鲜闭合性跟腱断裂的对照研究

目的 比较塑型卵圆钳经皮微创缝合技术和切开缝合技术治疗新鲜闭合性跟腱断裂的临床疗效。方法 回顾性研究自2014年1月至2016年10月收治的73例新鲜闭合性跟腱断裂病人，最终入组共70例，根据手术方式的不同分为两组：微创组（36例）借助自制的塑型卵圆钳，通过小切口经皮缝合修复跟腱；常规组（34例）采用常规跟腱内侧纵行切口，连续锁边缝合修复跟腱。记录两组手术时间、术中出血量、术后并发症、恢复至伤前运动水平的时间、末次随访时的美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分，术后1年复查MRI评估跟腱修复状况。结果 两组病人获得16~44个月（平均30个月）随访，其中微创组手术时间为（45.34±6.73） min，术中出血量为（15.12±4.11） ml；常规组手术时间为（69.33±13.44） min，术中出血量为（25.47±7.19） ml，两组比较，差异均有统计学意义（P均＜0.05）。微创组2例病人切口延迟愈合，2例出现线结刺激症状，1例腓肠神经损伤，1例于术后半年外伤后再断裂；常规组3例伤口浅表感染，2例出现深部感染，无腓肠神经损伤及跟腱再断裂。末次随访AOFAS评分：微创组为（95.81±2.35）分，常规组为（93.61±4.83）分；微创组有29例病人（21.0±4.7）周（20~24周）恢复至伤前运动水平，常规组有26例（23.0±3.5）周（21~31周）恢复至伤前运动水平；上述指标比较，差异均无统计学意义（P均＞0.05）。术后1年MRI均显示跟腱连续性完整，未观察到跟腱囊性变。结论 自制塑型卵圆钳经皮缝合技术修复新鲜闭合性跟腱断裂手术时间短，术后恢复更快，且并不增加跟腱再断裂发生率。

Comparison of efficacy between minimally invasive technique with suture-guided forceps and conventional technique in treating fresh Achilles tendon rupture

Objective To compare the clinical efficacy between minimally invasive technique with suture-guided forceps and conventional technique in treating fresh Achilles tendon rupture. Methods A retrospective study on 73 patients with fresh close Achilles tendon rupture was performed from January 2014 to October 2016. All patients were divided into two groups according to the surgical procedures: minimally invasive group and conventional group. Minimally invasive technique with suture-guided forceps was used in minimally invasive group, and conventional technique was utilized in conventional group. The operation time, intraoperative bleeding volume, incidence of complications and recovery time of the two groups were documented respectively. AOFAS was used to estimated the function of ankle joints, and the condition of Achilles tendon was evaluated by MRI 1 year later. Results All patients were followed up for 16 to 44 months (30 months on average). The operation time was (45.34±6.73) min and the intraoperative bleeding volume was (15.12±4.11) ml in minimally invasive group, and those were (69.33±13.44) min and (25.47±7.19) ml respectively in conventional group. The differences were significant between the two groups. In minimally invasive group, 2 cases showed delayed wound healing, 2 cases had suture clot irritation symptoms after operation and 1 patient suffered sural nerve injury; 1 patient sprained again to recurrent rupture of Achilles tendon half a year after operation. In conventional group, superficial wound infection occurred in 3 patients and deep wound infection occurred in 2 patients, and no sural nerve injury or recurrent rupture of Achilles tendon was reported. The final score of AOFAS was 95.81±2.35 in the minimally invasive group and 93.61±4.83 in conventional group. There was no statistically significant difference. In the minimally invasive group, 29 cases recovered to normal in (21.0±4.7) weeks (20-24 weeks). In conventional group, 26 cases recovered in (23.0±3.5) weeks (21-31 weeks). There was no significant difference between two groups. One year after operation, the two groups showed continuous and complete Achilles tendon on MRI, and no cystic degeneration of Achilles tendon was observed. Conclusion As compared with traditional surgery, minimally invasive suture has the advantages of shorter operation and recovery time. Meanwhile, it does not increase the recurrence and rupture rate of Achilles tendon.