闭合性跟腱断裂微创腱皮缝合的远期疗效观察.doc

1 闭合性跟腱断裂微创腱皮缝合的远期疗效观察作者:商晓军,朱亚平,韦兆祥【摘要】[目的]通过对长期疗效和可能并发症的观察, 介绍并评价微创腱皮缝合术治疗急性闭合性跟腱断裂的临床效果。[ 方法]自 1996 年1 月~ 2005 年4 月间, 随机选取跟腱断裂的患者 28 名,经术前查体和 MRI 证实,均为新鲜完全性闭合性跟腱断裂。首先微创暴露跟腱断端, 清除断端的瘢痕和血凝块, 梳理对合两断端, 在皮外经跟腱断端以远健康部位做减张缝合。患者常规术后随访,平均随访 4 年(1~7年) 。随访包括常规的临床评价和术后 MRI 检查,并应用 Arner 拟 Lindholm 疗效评定标准对术后效果进行评定。其中 2 例未能按时随访。[ 结果] 对所有 26 例患者,按 Arner 拟 Lindholm 疗效评定标准进行评定, 其中优 19例,良6例, 差1例, 优良率为 97%, 无感染发生, 再断裂 1例, 为长期局部类固醇封闭患者。术后 MRI 显示, 全部患者的跟腱得到了良好的修复,跟腱断端连续性好,疤痕小。[结论]通过长期随访, 微创腱皮缝合是一种修复急性闭合性跟腱断裂较 2 好的方法, 具有创伤小, 有效保护跟腱血运, 术后并发症少的优点。【关键词】跟腱;腱损伤;缝合技术 The long term result of the acute closed rupture of achilles tendon treated by the short incision and tenocutaneous relaxing suture Abstract :[ Objective ] To evaluate the long term effect of the short incision and tenocutaneous relaxing suture to treat the acute closed rupture of the Achilles tendon. [ Method ] 28 cases were treated by short incision and tenocutaneous relaxing suture from 1996-2005,The scar tissue and blood blocks between the ends of ruptured Achilles tendon were first pletely,then treated with percutanneous decmpression suture,the duration of follow up ranged from 2 years to 10 treatment e were evaluated by Arner 拟 Lindholm evaluation system and the MRI of post cases were lost. [ Result ] According to the Arner 拟 Lindholm evaluation system and the MRI of post operation,the treatment 3 e were excellent in 18,and good in 6,with excellent rate of 92%,plication including nerve injury and infection were found after operation,except 1 rerupture of Achilles tendon was found during the follow up MRI showed the rupture Achilles tendon were repaired and remodeled very well in all cases. [ Conclusion ] The short incision and tenocutaneous relaxing suture is an ideal surgical technique,with good Clinical result and less plication. Key words : achilles tendon; tendon injury; suture technique 闭合性跟腱断裂是一种常见的运动损伤, 目前治疗方法较多, 手术方式选择不当会引起较多的并发症[1], 影响跟腱的功能恢复。本科室近年来摸索出一种微创腱皮缝合技术来治疗急性闭合性跟腱断裂, 经过长期的随