Dogan Ahmet, Uzumcugil Onat, Sarisozen Bartu, Ozdemir Bulent, Akman Y Emre, Bozdag Ergun, Sunbuloglu Emin, Bozkurt Erol
J Child Orthop. 2009 Dec;3(6):485-91. doi: 10.1007/s11832-009-0207-4. Epub 2009 Oct 1.
To investigate the effect of Achilles tenotomy performed percutaneously and by mini-open methods on tendon healing and final strength.
In two groups, each consisting of 14 rats, percutaneous and mini-open techniques in Achilles tenotomy were compared in terms of biomechanical, histological and gross properties.
In the gross evaluation, it was observed that an obvious thickening and adhesion to the subcutaneous tissue of the healing tendon were observed in nearly all rats in which the mini-open technique was performed. In the biomechanical analysis, there was no significant difference between percutaneous and mini-open groups and between operated and intact Achilles tendons in both groups, in terms of tendon strength (P > 0.05). In the histological evaluation, irregularity in the parallel pattern of the collagen fibres, emergence of a non-specific collagenous tissue formation and infiltration of mild mononuclear inflammatory cells were reported. These changes were more marked in the rats in which the percutaneous technique was performed.
Mini-open technique for Achilles tenotomy may be considered as an alternative method of treatment to apply the tenotomy technique in a secure way.
There are two basic advantages of Achilles tenotomy performed by the mini-incision open technique: (1) a complete tenotomy is guaranteed, as it has to be in the original Ponseti technique, (2) iatrogenic neuro-vascular injury risk is nearly completely avoided due to the subparatenon exploration of the tendon and direct visual observation during the transection. The mini-open technique may only be used in cases in which a vascular compromise is clinically suspected or confirmed by Doppler ultrasonography and/or arteriography. On the other hand, the technique may be performed in all cases routinely by the choice of the surgeon.
研究经皮和小切口开放两种方法行跟腱切断术对肌腱愈合及最终强度的影响。
将两组各14只大鼠，在跟腱切断术的生物力学、组织学和大体特征方面，比较经皮和小切口开放技术。
在大体评估中，观察到采用小切口开放技术的几乎所有大鼠，愈合肌腱出现明显增厚并与皮下组织粘连。在生物力学分析中，经皮组和小切口开放组之间以及两组中手术侧与完整跟腱之间，在肌腱强度方面无显著差异（P>0.05）。在组织学评估中，报告有胶原纤维平行排列不规则、出现非特异性胶原组织形成以及轻度单核炎性细胞浸润。这些变化在采用经皮技术的大鼠中更明显。
跟腱切断术的小切口开放技术可被视为一种安全应用切断术的替代治疗方法。
小切口开放技术行跟腱切断术有两个基本优点：（1）能保证完全切断，如同原始的庞塞蒂技术那样；（2）由于在腱周膜下探查肌腱并在切断过程中直接目视观察，几乎完全避免了医源性神经血管损伤风险。小切口开放技术仅可用于临床怀疑或经多普勒超声和/或血管造影证实有血管受损的病例。另一方面，该技术可由外科医生根据选择在所有病例中常规施行。
