• 1 吉林大學(xué)中日聯(lián)誼醫(yī)院骨科（長(zhǎng)春，130000）;;
  • 大慶油田總醫(yī)院 2 骨科，5 藥劑科;;
  • 3 四平市第四人民醫(yī)院骨科;;
  • 4 大慶龍南醫(yī)院婦產(chǎn)科;

目的 通過(guò)與開(kāi)放縫合法比較，探討改良經(jīng)皮縫合法修復(fù)新鮮閉合性跟腱斷裂的療效。 方法 2006年1 月－ 2009 年10 月，收治50 例新鮮閉合性跟腱斷裂患者，根據(jù)治療方法不同分為兩組，22 例采用改良經(jīng)皮縫合法治療（改良組），術(shù)中于跟腱兩側(cè)平行各作5 個(gè)孔，采用“之”字形方式縫合；28 例采用Kesller 縫合法治療（常規(guī)組）。兩組患者性別、年齡、受傷至手術(shù)時(shí)間等一般資料比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。 結(jié)果 常規(guī)組術(shù)后1 例切口感染，1 例跟腱再斷裂，2 例切口瘢痕攣縮；改良組患者切口均Ⅰ期愈合，無(wú)并發(fā)癥發(fā)生。改良組手術(shù)時(shí)間為（38.7 ± 6.6）min，明顯短于常規(guī)組（52.3 ± 6.9）min（t= —12.29，P=0.00）；改良組術(shù)中失血量為（4.9 ± 2.0）mL，顯著低于常規(guī)組（40.7 ± 7.1）mL（t= —25.20，P=0.00）。兩組患者均獲隨訪(fǎng)，隨訪(fǎng)時(shí)間2 ～ 3 年，平均 29.9 個(gè)月。術(shù)后2 年應(yīng)用美國(guó)矯形足踝協(xié)會(huì)（A OFAS）評(píng)分標(biāo)準(zhǔn)評(píng)定，改良組為（99.6 ± 1.0）分，常規(guī)組為（98.4 ± 3.0）分，差異無(wú)統(tǒng)計(jì)學(xué)意義（t=1.66，P=0.10）。 結(jié)論 與開(kāi)放縫合法比較，改良經(jīng)皮縫合法具有手術(shù)操作簡(jiǎn)便、并發(fā)癥少、踝關(guān)節(jié)功能恢復(fù)快等優(yōu)點(diǎn)，是治療新鮮閉合性跟腱斷裂的較好選擇之一。

引用本文： 初海坤,徐衍斌,初海鵬,徐亞軍,周鳳吉,于欣,李慧,季曉風(fēng). 改良經(jīng)皮縫合法與開(kāi)放縫合法修復(fù)新鮮閉合性跟腱斷裂的療效比較. 中國(guó)修復(fù)重建外科雜志, 2012, 26(6): 708-711. doi: 復(fù)制

1. Khan RJ, Fick D, Keogh A, et al. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10): 2202-2210.
2. Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
3. Cretnik A, Kosanovi? M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg, 2004, 43(2): 72-81.
4. 張國(guó)柱, 蔣協(xié)遠(yuǎn), 王滿(mǎn)宜. 有限切開(kāi)腱周內(nèi)縫合法治療新鮮閉合性跟腱斷裂. 山東醫(yī)藥, 2010, 50(44): 22-24.
5. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
6. 商曉軍, 朱亞平, 韋兆祥. 閉合性跟腱斷裂微創(chuàng)腱皮縫合的遠(yuǎn)期療效觀(guān)察. 中國(guó)矯形外科雜志, 2007, 15(18): 1371-1373.
7. Maes R, Copin G, Averous C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg, 2006, 72(2): 179-183.
8. Bosworth DM. Repair of defects in the tendo Achillis. J Bone Joint Surg (Am), 1956, 38-A(1): 111-114.
9. Sato M, Maeda M, Kurosawa H, et al. Reconstruction of rabbit Achilles tendon with three bioabsorbable materials: histological and biomechanical studies. J Orthop Sci, 2000, 5(3): 256-267.
10. Suchak AA, Spooner C, Reid DC, et al. Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis. Clin Orthop Relat Res, 2006, (445): 216-221.
11. Ajis A, Maffulli N. Management of acute tendo Achilles ruptures. Foot Ankle Surg, 2007, 13: 132-135.
12. Poynton AR, O’Rourke K. An analysis of skin perfusion over the Achilles tendon in varying degrees of plantarflexion. Foot Ankle Int, 2001, 22(7): 572-574.
13. Costa ML, MacMillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilization for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
14. Ingvar J, Tägil M, Eneroth M. Nonoperative treatment of Achilles rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop, 2005, 76(4): 597-601.
15. Wada A, Kubota H, Akiyama T, et al. Effect of absorbable polydioxanone flexor tendon repair and restricted active mobilization in a canine model. J Hand Surg (Am), 2001, 26(3): 398-406.
  1. 1. Khan RJ, Fick D, Keogh A, et al. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg (Am), 2005, 87(10): 2202-2210.
  2. 2. Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
  3. 3. Cretnik A, Kosanovi? M, Smrkolj V. Percutaneous suturing of the ruptured Achilles tendon under local anesthesia. J Foot Ankle Surg, 2004, 43(2): 72-81.
  4. 4. 張國(guó)柱, 蔣協(xié)遠(yuǎn), 王滿(mǎn)宜. 有限切開(kāi)腱周內(nèi)縫合法治療新鮮閉合性跟腱斷裂. 山東醫(yī)藥, 2010, 50(44): 22-24.
  5. 5. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
  6. 6. 商曉軍, 朱亞平, 韋兆祥. 閉合性跟腱斷裂微創(chuàng)腱皮縫合的遠(yuǎn)期療效觀(guān)察. 中國(guó)矯形外科雜志, 2007, 15(18): 1371-1373.
  7. 7. Maes R, Copin G, Averous C. Is percutaneous repair of the Achilles tendon a safe technique? A study of 124 cases. Acta Orthop Belg, 2006, 72(2): 179-183.
  8. 8. Bosworth DM. Repair of defects in the tendo Achillis. J Bone Joint Surg (Am), 1956, 38-A(1): 111-114.
  9. 9. Sato M, Maeda M, Kurosawa H, et al. Reconstruction of rabbit Achilles tendon with three bioabsorbable materials: histological and biomechanical studies. J Orthop Sci, 2000, 5(3): 256-267.
  10. 10. Suchak AA, Spooner C, Reid DC, et al. Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis. Clin Orthop Relat Res, 2006, (445): 216-221.
  11. 11. Ajis A, Maffulli N. Management of acute tendo Achilles ruptures. Foot Ankle Surg, 2007, 13: 132-135.
  12. 12. Poynton AR, O’Rourke K. An analysis of skin perfusion over the Achilles tendon in varying degrees of plantarflexion. Foot Ankle Int, 2001, 22(7): 572-574.
  13. 13. Costa ML, MacMillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilization for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
  14. 14. Ingvar J, Tägil M, Eneroth M. Nonoperative treatment of Achilles rupture: 196 consecutive patients with a 7% re-rupture rate. Acta Orthop, 2005, 76(4): 597-601.
  15. 15. Wada A, Kubota H, Akiyama T, et al. Effect of absorbable polydioxanone flexor tendon repair and restricted active mobilization in a canine model. J Hand Surg (Am), 2001, 26(3): 398-406.