跟腱断裂术后即刻功能锻炼的临床研究

目的:通过与跟腱断裂术后2周进行功能锻炼及下地部分负重行走的比较,探讨跟腱断裂术后即刻功能锻炼及下地部分负重行走对患肢功能及跟腱再断裂的影响。方法:将2012年3月至2013年3月收治的64例闭合性跟腱断裂手术患者分为两。治疗组34例,男18例,女16例;年龄(41.4±7.6)岁;于术后第2天即行功能锻炼及佩戴支具下地部分负重行走。对照组30例,男16例,女14例;年龄(39.9±7.6)岁;术后予患肢短腿石膏跖屈位固定2周,2周后行功能锻炼及佩戴支具下地部分负重行走。两组患者由同一组医生采用相同的手术方式处理,观察并比较两组患者AOFAS踝关节功能评分、跟腱再断裂及伤口并发症情况。结果 :术后2个月AOFAS评分治疗组74.3±3.9,对照组71.7±4.2,治疗组高于对照组;术后1年治疗组93.3±3.9,对照组92.0±4.1,两组比较差异无统计学意义。术后治疗组无跟腱再断裂,对照组1例发生跟腱再断裂;术后治疗组2例发生伤口并发症,对照组1例发生并发症,差异无统计学意义。结论:跟腱断裂术后患者即刻功能锻炼,踝关节AOFAS功能评分优于固定2周后再行功能锻炼,同时不增加术后跟腱再断裂率及并发症发生率,有利于患肢功能恢复。

Clinical investigate of functional exercise immediate after operation for Achilles tendon rupture

Objective:To investigate clinical effect of partly weight-bearing walking and functional exercise immediatly after operation for Achilles tendon rupture(ATR) on function of ankle joint and rate of fragmentation of Achilles tendon,through comparing effect of partly weight-bearing walking and functional exercise immediatly at 2 weeks after operation for Achilles tendon rupture.

Methods:Sixty-four patients with ATR selected from March 2012 to March 2013 were randomly divided into two groups. There were 34 patients in treatment group,including 18 males and 16 females with an average age of 41.4±7.6,they began to do functional exercise and walk on fields with partly weight-bearing at two days after operation;there were 30 patients in control group,including 16 males and 14 females with an average age of 39.9±7.6,and they were immobilized with plaster in plantar flexion at two weeks after operation,and started to do functional exercise and walk on fields with partly weight-bearing at two weeks after operation. Two groups were performed by the same doctor with the same operation. The rate of fragmentation of Achilles tendon,and AOFAS score and complications between two groups were observed and compared.

Results:AOFAS score in treatment group at two weeks after operation was 74.3±3.9,which in control group was 71.7±4.2,and had statistical differences between two groups;AOFAS score in treatment group at one year after operation was 93.3±3.9,which in control group was 92.0±4.1,and had no statistical significance. No Achilles tendon fragmentation in treatment group occurred at three years after operation,and 1 patient occurred in control group. Two patients in treatment group occurred complications after operation,and 1 patient occurred in control group,however,there was no statistical significance between two groups.

Conclusion:Functional exercise immediate after operation for Achilles tendon rupture(ATR) patients in the early days,the AOFAS scores is higher than the fixing for two weeks,and does not increase the rate of fragmentation of Achilles tendon and complication after operation,and benefits for function recovery.