Hopital Universitaire de Bicetre, AP-HP, Univ Paris-Sud, Department of Orthopedic Surgery, 78 rue du General Leclerc, 94270 Le Kremlin-Bicetre, France.
Foot Ankle Int. 2010 Dec;31(12):1069-74. doi: 10.3113/FAI.2010.1069.
The purpose of the study was to determine whether real-time intraoperative ultrasonography improved implant positioning and stump approximation in patients with acute Achilles tendon rupture managed percutaneously.
The needles were introduced percutaneously without ultrasonography and their position was checked relative to cutaneous landmarks and by palpation. Then, intraoperative ultrasonography was performed to assess needle position at the proximal tendon segment, tendon tear, and distal tendon segment. Incorrectly placed needles were removed and reinserted under real-time ultrasonographic guidance. Tendon apposition was checked ultrasonographically.
We included 21 patients (19 males, two females) with unilateral acute Achilles tendon rupture, in whom 42 needles (one medial and one lateral) were inserted. Correct positioning was achieved without ultrasonographic guidance for 19 (45%) needles overall, 15 of 21 (71%) medial needles, and four of 21 (19%) lateral needles. The remaining 23 needles were correctly repositioned under ultrasonographic guidance. The correct positioning rates with and without ultrasonography differed significantly for all needles (p < 0.0001) and for lateral needles (p < 0.0001) but not for medial needles (p = 0.03). Intraoperative ultrasonography confirmed tendon stump approximation in all cases.
Without imaging, 55% of needles were correctly positioned. Intraoperative ultrasonography allowed correct positioning of all needles and provided intraoperative confirmation of stump approximation.
本研究旨在确定实时术中超声是否能改善经皮治疗急性跟腱断裂患者的植入物定位和残端吻合。
在不使用超声的情况下经皮引入针，并通过触诊和体表标志检查其位置。然后，进行术中超声检查，以评估近端肌腱段、肌腱撕裂和远端肌腱段的针的位置。将位置不正确的针取出，并在实时超声引导下重新插入。通过超声检查检查肌腱对合。
我们纳入了 21 例单侧急性跟腱断裂患者（19 名男性，2 名女性），共插入 42 根针（1 根内侧和 1 根外侧）。在不使用超声引导的情况下，总共正确定位了 19 根（45%）针，21 根内侧针中有 15 根（71%），21 根外侧针中有 4 根（19%）。其余 23 根针在超声引导下正确重新定位。所有针（p<0.0001）和外侧针（p<0.0001）的正确定位率与无超声检查时差异有统计学意义，但内侧针（p=0.03）无差异。术中超声确认了所有病例的肌腱残端接近。
不进行成像时，55%的针被正确定位。术中超声可使所有针正确定位，并提供术中残端吻合的确认。
