【摘要】：目的探討利用帶線錨釘半Kessler縫合法修復(fù)自發(fā)性跟腱斷裂的臨床效果。方法 2011年1月-2013年12月采用帶線錨釘半Kessler縫合法修復(fù)自發(fā)性跟腱腱性部位斷裂患者31例。其中男23例,女8例;年齡16~53歲,平均38歲。左足15例,右足16例。致傷原因:體育運(yùn)動(dòng)中突發(fā)足跟部疼痛、行走無力22例,下樓踩空、滑倒、搬重物等原因9例。斷裂部位距離跟骨止點(diǎn)3~6 cm,平均4.2 cm。受傷至手術(shù)時(shí)間為7 h~4 d,平均36.8 h。結(jié)果所有患者切口均Ⅰ期愈合,無腓腸神經(jīng)損傷表現(xiàn),跟腱修復(fù)部位與皮膚無粘連。31例患者均獲隨訪,隨訪時(shí)間6~24個(gè)月,平均15個(gè)月。術(shù)后6個(gè)月所有患者均可順利完成25次提踵活動(dòng);隨訪期間無跟腱再斷裂發(fā)生。術(shù)后6個(gè)月健、患側(cè)踝關(guān)節(jié)背伸及跖屈范圍比較差異均無統(tǒng)計(jì)學(xué)意義(t=0.648,P=0.525;t=0.524,P=0.605)。術(shù)后6個(gè)月患側(cè)小腿最大周徑明顯小于健側(cè)(t=2.074,P=0.041),但術(shù)后12個(gè)月健、患側(cè)比較差異無統(tǒng)計(jì)學(xué)意義(t=0.905,P=0.426)。術(shù)后6、12、18、24個(gè)月患者美國矯形足踝協(xié)會(huì)(AOFAS)評(píng)分均顯著高于術(shù)前(P0.05);術(shù)后除6個(gè)月評(píng)分低于其余各時(shí)間點(diǎn)(P0.05)外,其余各時(shí)間點(diǎn)間差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論帶線錨釘半Kessler縫合法修復(fù)自發(fā)性跟腱斷裂,不但可提供強(qiáng)大的修復(fù)拉力,而且降低了縫線對(duì)肌腱的切割力,是一種可供選擇的良好修復(fù)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.
【作者單位】： 陜西省人民醫(yī)院骨科;
【基金】：陜西省自然基礎(chǔ)研究計(jì)劃資助項(xiàng)目(2014JQ4125)~~
【分類號(hào)】：R687.2

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