Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
Foot Ankle Surg. 2010 Mar;16(1):28-31. doi: 10.1016/j.fas.2009.04.004. Epub 2009 May 15.
Acute Achilles tendon ruptures is one of the commonest tendon injury of the foot and ankle. The management of this problem is still controversial. Treatment can be classified into non-surgical and surgical types. Surgical management can be subdivided into open repair, percutaneous with or without adjunct of arthroscopy. In compare with non-surgical management, surgical management will decrease the tendon re-rupture rate. However, the possible surgical complications including wound breakdown and sural nerve injury are still quite significant. Percutaneous repair technique has the advantage of less chance of wound breakdown, but the rate of tendon re-rupture is higher than that after open tendon repair, because the repair is usually weaker than that achieved in open repair. Lui have described an endoscopic assisted repair with the Krackow locking suture. However, the technique is complicated and six portal wounds are needed. A simpler way of applying the Krackow suture through the portal wound has been described for reattachment of Achilles tendon insertion after endoscopic calcaneoplasty. We describe a mini-open approach of Achilles tendon repair with the Krackow locking suture. By means of release of the medial edge of the investing fascia, the Achilles tendon can be mobilized easily and the Krackow locking suture can be applied through a 1.5cm medial wound. Hopefully, this can improve the strength of repair and maintaining the advantage of minimally invasive tendon repair.
急性跟腱断裂是足部和踝关节最常见的肌腱损伤之一。这个问题的处理仍然存在争议。治疗可以分为非手术和手术两种类型。手术治疗可以分为开放性修复、经皮修复,有无关节镜辅助。与非手术治疗相比,手术治疗可以降低跟腱再次断裂的发生率。然而,可能的手术并发症,包括伤口破裂和腓肠神经损伤,仍然相当显著。经皮修复技术的优点是伤口破裂的机会较少,但跟腱再次断裂的发生率高于开放性肌腱修复后,因为修复通常不如开放性修复牢固。吕(Lui)曾描述过一种关节镜辅助修复,采用 Krackow 锁定缝合。然而,该技术复杂,需要六个通道口。有人描述了一种通过通道口应用 Krackow 缝合线的更简单方法,用于内镜跟骨后Calcaneoplasty 后跟腱附着处的再附着。我们描述了一种使用 Krackow 锁定缝合线的微创跟腱修复的小切口方法。通过松解内侧筋膜的边缘,可以轻松地移动跟腱,并通过 1.5cm 的内侧伤口应用 Krackow 锁定缝合线。希望这种方法可以提高修复的强度,并保持微创肌腱修复的优势。