层叠斜面缝合法修复新鲜闭合性跟腱断裂早期疗效观察

发布时间：2018-04-11 09:47

本文选题：闭合性跟腱断裂 + 层叠斜面缝合法　；参考：《中国修复重建外科杂志》2017年12期

【摘要】：目的介绍一种修复新鲜闭合性跟腱断裂的改良方法,初步探讨其临床效果。方法 2011年3月—2015年9月,采用层叠斜面缝合法手术修复8例(8侧)新鲜闭合性跟腱断裂。患者均为男性;年龄22~58岁,平均39.3岁。为运动中损伤,局部无直接暴力。提踵试验及Thompson试验均呈阳性。彩色多普勒超声或MRI检查确定跟腱完全断裂,断端距跟骨止点2~5 cm,平均3.3 cm。伤后至手术时间为2~12 d,平均4.1 d。采用后正中偏内侧纵向切口暴露,将跟腱断端在冠状面上分3层,断端梳理成条带状,交错层叠,跟腱纤维斜面侧侧缝合。术后踝关节跖屈保护位外固定,早期开始康复锻炼。结果手术时间70~135 min,平均99 min;术中出血量5~30 mL,平均15.6 mL。除1例拆线后切口部分裂开,经换药愈合外,其余切口均Ⅰ期愈合,无感染发生。8例均获随访,随访时间6~50个月,平均30.5个月。无腓肠神经损伤、局部疼痛及下肢深静脉血栓形成等并发症发生。所有患者均恢复至跟腱断裂前运动水平,行走正常,提踵有力,未发生跟腱再断裂。与健侧对比,踝关节活动度背伸减少0~6°,平均3°;跖屈减少1~5°,平均2°。末次随访时按照Arner-Lindholm疗效评定标准,优7例,良1例,优良率100%。结论层叠斜面缝合法操作简便,无需特殊器械,可提供早期康复锻炼的抗拉强度,患者恢复快,早期疗效较好。
[Abstract]:Objective to introduce an improved method for repairing fresh closed rupture of Achilles tendon.Methods from March 2011 to September 2015, 8 cases of fresh closed rupture of Achilles tendon were repaired by laminated oblique suture.All the patients were male, aged 22 to 58 years (mean 39.3 years).For sports injury, no direct local violence.Both the heel test and Thompson test were positive.The complete rupture of Achilles tendon was confirmed by color Doppler ultrasound or MRI. The distance between the end of the rupture and the calcaneal insertion was 2 ~ 5 cm, with an average of 3.3 cm.The operation time from injury to operation was 2: 12 days with an average of 4. 1 days.The distal end of Achilles tendon was divided into three layers on the coronal plane by the longitudinal incision of the medial posterior medial side. The broken end was carded into strips, staggered and laminated, and the Achilles tendon fibers were sutured on the oblique side.After operation, the ankle metatarsal flexion was fixed with external fixation, and early rehabilitation exercise began.Results the operative time was 70 ~ 135 min (mean 99 min) and the intraoperative bleeding volume was 530 mL (15.6 mL).Except for one case, the incision was partially split and healed after dressing change. All the other incisions were healed in the first stage. All the cases were followed up without infection. The follow-up time was 6 ~ 50 months (mean 30.5 months).There were no complications such as sural nerve injury, local pain and deep venous thrombosis of lower extremity.All the patients recovered to the level of movement before the rupture of Achilles tendon, walked normally, had the strength of lifting the heel, and did not rerupture the Achilles tendon.Compared with the normal side, the motion of the ankle joint decreased by 0 掳6 掳(mean 3 掳), and the flexion of the metatarsal decreased by 1 掳(2 掳).According to Arner-Lindholm criteria, 7 cases were excellent, 1 case was good, and the excellent and good rate was 100%.Conclusion the laminated oblique suture method is easy to operate and does not need special instruments. It can provide the tensile strength of early rehabilitation exercise. The patients recover quickly and the early curative effect is better.
【作者单位】：江苏大学附属医院骨科;
【分类号】：R687.2

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