闭合性跟腱断裂微创腱皮缝合的远期疗效观察

[目的]通过对长期疗效和可能并发症的观察,介绍并评价微创腱皮缝合术治疗急性闭合性跟腱断裂的临床效果。[方法]自1996年1月～2005年4月间,随机选取跟腱断裂的患者28名,经术前查体和MRI证实,均为新鲜完全性闭合性跟腱断裂。首先微创暴露跟腱断端,清除断端的瘢痕和血凝块,梳理对合两断端,在皮外经跟腱断端以远健康部位做减张缝合。患者常规术后随访,平均随访4年（1～7年）。随访包括常规的临床评价和术后MRI检查,并应用Arner-Lindholm疗效评定标准对术后效果进行评定。其中2例未能按时随访。[结果]对所有26例患者,按Arner-Lindholm疗效评定标准进行评定,其中优19例,良6例,差1例,优良率为97%,无感染发生,再断裂1例,为长期局部类固醇封闭患者。术后MRI显示,全部患者的跟腱得到了良好的修复,跟腱断端连续性好,疤痕小。[结论]通过长期随访,微创腱皮缝合是一种修复急性闭合性跟腱断裂较好的方法,具有创伤小,有效保护跟腱血运,术后并发症少的优点。

The long term result of the acute closed rupture of achilles tendon treated by the short incision and tenocutaneous relaxing suture

[Objective]To evaluate the long term effect of the short incision and tenocutaneous relaxing suture to treat the acute closed rupture of the Achilles tendon.[Method]28 cases were treated by short incision and tenocutaneous relaxing suture from 1996-2005,The scar tissue and blood blocks between the ends of ruptured Achilles tendon were first debrided completely,then treated with percutanneous decmpression suture,the duration of follow up ranged from 2 years to 10 years.The treatment outcome were evaluated by Arner-Lindholm evaluation system and the MRI of post operation.2 cases were lost.[Result]According to the Arner-Lindholm evaluation system and the MRI of post operation,the treatment outcome were excellent in 18,and good in 6,with excellent rate of 92%,No complication including nerve injury and infection were found after operation,except 1 rerupture of Achilles tendon was found during the follow up period.The MRI showed the rupture Achilles tendon were repaired and remodeled very well in all cases.[Conclusion]The short incision and tenocutaneous relaxing suture is an ideal surgical technique,with good Clinical result and less Significant complication.