Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China.
Foot Ankle Surg. 2009;15(4):183-6. doi: 10.1016/j.fas.2009.02.006. Epub 2009 Apr 5.
To study the feasibility of applying Krackow locking stitches in the endoscopic-assisted repair of acute Achilles tendon rupture and the possible complications encountered.
Anatomic study.
Twelve Achilles tendons in six cadavers were cut at 6cm from its insertion and endoscopic-assisted repair of Achilles tendon was performed. These legs were then cut open in midline to study (i) the locking stitches formed and (ii) the relation of the sural nerve to the locking stitches.
With endoscopic-assisted technique, Krackow-type locking stitches can be formed in eight legs. In four legs, the stitches fell into the ruptured gap and lie deep to the tendon. The tendon rupture end was grasped by the suture rather than forming a Krackow-type locking stitch when the suture was tightened. There was no sural nerve laceration noted. However, in two legs, the sural nerves were found trapped in the sutures at around the proximal portal.
Krackow locking stitches can be formed by the minimally invasive technique. However, there are risks of stitches falling into the ruptured gap and lie deep to the tendon and risk of sural nerve entrapment at the proximal medial portal. The original technique is not suitable for clinical application. Modification of the technique by grasping the tendon end with Allis tissue forceps before passing the suture may prevent the suture from falling into the ruptured tendon gap.
研究在急性跟腱断裂的内镜辅助修复中应用 Krackow 锁边缝合的可行性及可能遇到的并发症。
解剖学研究。
在 6 具尸体的跟腱距其止点 6cm 处切断，行内镜辅助下跟腱修复。然后在正中切开这些腿，研究（i）形成的锁边缝合，以及（ii）腓肠神经与锁边缝合的关系。
采用内镜辅助技术，8 条腿可形成 Krackow 型锁边缝合。4 条腿的缝线落入断裂间隙并位于肌腱深部。当缝线收紧时，缝线并未抓住肌腱断裂端，而是形成 Krackow 型锁边缝合。未发现腓肠神经撕裂。然而，在两条腿中，发现腓肠神经在近端内侧入路处被缝线困住。
微创技术可形成 Krackow 锁边缝合，但存在缝线落入断裂肌腱间隙并位于肌腱深部以及近端内侧入路处腓肠神经受压的风险。原始技术不适合临床应用。改良技术通过在缝线穿过前用 Allis 组织钳抓住肌腱端，可能防止缝线落入断裂的肌腱间隙。
