Maes Renaud, Copin Gerard, Averous Christophe
Clinique Louis Caty, Baudour, Belgium.
Acta Orthop Belg. 2006 Apr;72(2):179-83.
Ma and Griffith first described in 1977 a percutaneous technique for the repair of acute Achilles tendon rupture. In 1992, Delponte popularised a new percutaneous technique with Tenolig. The authors report a series of 124 cases of Achilles tendon rupture treated with Tenolig in their institution from 1993 to 1998. There were 79 men and 45 women. The mean age was 41.5 years, with a peak from 30 to 39 years. The rupture occurred during sports activities in 69 cases. The mean duration of follow-up was 1.9 years. Surgical complications noted were: unbending of one of the harpoon wires in 5 cases, rupture of the harpoon wire in one case and tendon re-rupture in 12 cases. The rate of re-rupture was similar to the rate noted with conservative treatment (10%). Skin necrosis at the entrance wound was noted in 10 cases, and injury of the sural nerve in 8 cases. Full weight-bearing without crutches was regained for 95% of patients within 3 months. In conclusion, this report shows a high rate of re-rupture and sural nerve entrapment with percutaneous surgery (Tenolig). The high rate of re-rupture can be due to the progressive but immediate weight-bearing allowed without an orthosis, or to inadequate apposition of the tendon ends, or to delay before repair. The high rate of sural nerve entrapment is due to its proximity to the Achilles tendon. We believe that a limited open technique is more reliable and has the advantage of allowing direct visualisation of the repair site and controlling adequate apposition of the tendon ends.
马和格里菲斯于1977年首次描述了一种经皮修复急性跟腱断裂的技术。1992年，德尔庞特推广了一种使用Tenolig的新型经皮技术。作者报告了他们机构在1993年至1998年期间用Tenolig治疗的124例跟腱断裂病例。其中男性79例，女性45例。平均年龄为41.5岁，30至39岁为发病高峰。69例断裂发生在体育活动期间。平均随访时间为1.9年。记录的手术并发症有：5例鱼叉线之一弯曲，1例鱼叉线断裂，12例肌腱再次断裂。再次断裂率与保守治疗记录的比率相似（10%）。10例出现伤口入口处皮肤坏死，8例出现腓肠神经损伤。95%的患者在3个月内恢复了无需拐杖的完全负重。总之，本报告显示经皮手术（Tenolig）的再次断裂和腓肠神经卡压发生率较高。再次断裂率高可能是由于在没有矫形器的情况下允许逐渐但立即负重，或由于肌腱断端对合不充分，或由于修复前延迟。腓肠神经卡压发生率高是由于其靠近跟腱。我们认为有限切开技术更可靠，并且具有能够直接观察修复部位和控制肌腱断端充分对合的优点。
