带线锚钉半Kessler缝合法修复自发性跟腱断裂

发布时间：2018-11-12 07:38

【摘要】：目的探讨利用带线锚钉半Kessler缝合法修复自发性跟腱断裂的临床效果。方法 2011年1月-2013年12月采用带线锚钉半Kessler缝合法修复自发性跟腱腱性部位断裂患者31例。其中男23例,女8例;年龄16~53岁,平均38岁。左足15例,右足16例。致伤原因:体育运动中突发足跟部疼痛、行走无力22例,下楼踩空、滑倒、搬重物等原因9例。断裂部位距离跟骨止点3~6 cm,平均4.2 cm。受伤至手术时间为7 h~4 d,平均36.8 h。结果所有患者切口均Ⅰ期愈合,无腓肠神经损伤表现,跟腱修复部位与皮肤无粘连。31例患者均获随访,随访时间6~24个月,平均15个月。术后6个月所有患者均可顺利完成25次提踵活动;随访期间无跟腱再断裂发生。术后6个月健、患侧踝关节背伸及跖屈范围比较差异均无统计学意义(t=0.648,P=0.525;t=0.524,P=0.605)。术后6个月患侧小腿最大周径明显小于健侧(t=2.074,P=0.041),但术后12个月健、患侧比较差异无统计学意义(t=0.905,P=0.426)。术后6、12、18、24个月患者美国矫形足踝协会(AOFAS)评分均显著高于术前(P0.05);术后除6个月评分低于其余各时间点(P0.05)外,其余各时间点间差异均无统计学意义(P0.05)。结论带线锚钉半Kessler缝合法修复自发性跟腱断裂,不但可提供强大的修复拉力,而且降低了缝线对肌腱的切割力,是一种可供选择的良好修复方法。
[Abstract]:Objective to investigate the clinical effect of repairing spontaneous rupture of Achilles tendon by semi-Kessler suture with wire anchor nail. Methods from January 2011 to December 2013, 31 patients with spontaneous rupture of Achilles tendon were repaired by semi-Kessler suture with wire anchor nail. There were 23 males and 8 females with a mean age of 38 years (16 53 years). Left foot 15 cases, right foot 16 cases. The causes of injury were as follows: sudden heel pain, walking weakness in 22 cases, trampling, slipping and lifting heavy objects in 9 cases. The distance from the fracture site to the calcaneal insertion point is 3 cm, an average of 4.2 cm.. The time from injury to operation was 7 hours and 4 days, with an average of 36.8 hours. Results all the incisions healed in the first stage, and there was no sign of sural nerve injury, and there was no adhesion between the repair site of the Achilles tendon and the skin. All the 31 patients were followed up for 6 ~ 24 months (mean 15 months). After 6 months, all patients were able to successfully complete 25 heel-lifting activities, and no recurrence of Achilles tendon occurred during follow-up. 6 months after operation, there was no significant difference in the range of dorsal extension and plantar flexion of the affected ankle joint (t: 0. 648, P = 0. 525, P = 0. 524, P = 0. 605). At 6 months after operation, the maximum circumference diameter of the affected leg was significantly smaller than that of the healthy side (t = 2.074, P < 0.041), but there was no significant difference between the affected sides at 12 months after operation (t = 0.905, P < 0.426). The (AOFAS) scores of the American Orthopaedic ankle Association were significantly higher than those before operation (P 0.05). Except the score of 6 months was lower than the other time points (P0.05), there was no significant difference between the other time points (P0.05). Conclusion the repair of spontaneous Achilles tendon rupture by semi-Kessler suture with wire anchor nail can not only provide strong tensile force, but also reduce the cutting force of suture to tendon, so it is a good method to repair the tendon.
【作者单位】：陕西省人民医院骨科;
【基金】：陕西省自然基础研究计划资助项目(2014JQ4125)~~
【分类号】：R687.2

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