改良经皮微创修复术治疗急性闭合性跟腱断裂的疗效

Effect of modified percutaneous minimally invasive repair surgery in treatment of patients with acute closed rupture of Achilles's tendon

  • 摘要:
      目的  探讨改良经皮微创修复术对急性闭合性跟腱断裂患者踝关节功能的影响。
      方法  回顾性分析63例急性闭合性跟腱断裂患者的临床资料,均予以改良经皮微创修复术治疗,观察治疗后的优良率、手术时间、切口长度、平均住院时间及并发症发生率;比较术前、术后1、3、7个月的美国足踝外科协会(AOFAS)评分、跟腱完全断裂评分(ATRS)、视觉模拟评分法(VAS)评分;分析AOFAS评分与ATRS评分、VAS评分的相关性;观察术后1、3、7个月的踝关节跖屈肌力、踝关节活动度、跟腱长度。
      结果  63例患者经改良经皮微创修复术治疗后优良率为92.06%;手术时间(33.72±6.52)min、切口长度(2.45±0.52)cm、平均住院时间(3.14±0.32)d;术后未出现感染、跟腱撕裂、跟腱再断裂等并发症;术后随访7个月,经B超、MRI等影像学检查,患侧跟腱修复良好,跟腱断端连续性良好。单因素方差分析显示,术后1、3、7个月的AOFAS评分、ATRS评分显著高于术前,而VAS评分低于术前,差异有统计学意义(P < 0.05)。Pearson相关性分析显示,AOFAS评分与ATRS评分呈正相关(r=0.902,P < 0.05),与VAS评分呈负相关(r=-0.676,P < 0.05)。单因素方差分析显示,术后7个月的踝关节跖屈肌力、踝关节活动度、跟腱长度高于术后1、3个月(P < 0.05);治疗后患者满意度为88.89%。
      结论  改良经皮微创修复术用于治疗急性闭合性跟腱断裂疗效显著,具有损伤小、手术时间短、术后恢复快等优势。

     

    Abstract:
      Objective  To explore the effect of modified percutaneous minimally invasive repair surgery on ankle joint function of patients with acute closed rupture of Achilles's tendon.
      Methods  The clinical materials of 63 patients with acute closed rupture of Achilles's tendon were retrospectively analyzed, and all of them were treated with modified percutaneous minimally invasive repair surgery. The excellent and good rate, operation time, incision length, average hospital stay and incidence rate of complication after treatment were observed. American Society of Foot and Ankle Surgery (AOFAS) score, Achilles's tendon complete rupture score (ATRS) and Visual Analogue Scale (VAS) score at the time points of before operation and 1 month, 3 and 7 months after operation were compared. Correlations between AOFAS score and ATRS score as well as VAS score were analyzed. Ankle plantar flexor strength, ankle range of motion and Achilles tendon length at 1 month, 3 and 7 months after surgery were observed.
      Results  The excellent and good rate of 63 patients after modified percutaneous minimally invasive repair surgery was 92.06%. Operation time, incision length and average hospital stay were (33.72±6.52) min, (2.45±0.52) cm and (3.14±0.32) d, respectively. No complications such as infection, Achilles's tendon tear and Achilles's tendon re-rupture were observed after operation. In the postoperative follow up of 7 months, the type B ultrasound, MRI and other imaging examinations showed that the Achilles's tendon on the affected side was repaired well, and the broken end of Achilles's tendon had good continuity. One way ANOVA showed that the AOFAS score and ATRS score at 1, 3 and 7 months after surgery were significantly higher than those before surgery, while the VAS score was significantly lower than that before surgery (P < 0.05). Pearson correlation analysis showed that AOFAS score was positively correlated with ATRS score (r=0.902, P < 0.05), and negatively correlated with VAS score (r=-0.676, P < 0.05). One way ANOVA showed that the ankle plantar flexor strength, ankle range of motion and Achilles's tendon length at 7 months after surgery were significantly higher than those at 1 month and 3 months after surgery (P < 0.05). The satisfaction degree of patients after treatment was 88.89%.
      Conclusion  Modified percutaneous minimally invasive repair surgery is effective in the treatment of patients with acute closed rupture of Achilles's tendon, which has the advantages of less injury, short operation time and rapid postoperative recovery.

     

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