Wang Ting, Mei Guohua, Shi Zhongmin, Chai Yimin, Zhang Changqing, Hou Chunlin
Department of Orthopaedics, Shanghai Changzheng Hospital, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Jul;26(7):814-8.
To compare the effectiveness of the 3 methods (traditional open Achilles tendon anastomosis, minimally invasive percutaneous Achilles tendon anastomosis, and Achilles tendon anastomosis limited incision) for acute Achilles tendon rupture so as to provide a reference for the choice of clinical treatment plans.
Between December 2007 and March 2010, 69 cases of acute Achilles tendon rupture were treated by traditional open Achilles tendon anastomosis (traditional group, n=23), by minimally invasive percutaneous Achilles tendon anastomosis (minimally invasive group, n=23), and by Achilles tendon anastomosis limited incision (limited incision group, n=23). There was no significant difference in gender, age, mechanism of injury, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 3 groups (P > 0.05).
Minimally invasive group and limited incision group were significantly better than traditional group in hospitalization days and blood loss (P < 0.01). Incision infection occurred in 2 cases of traditional group, and healing of incision by first intention was achieved in all patients of the other 2 groups, showing significant difference in the complication rate (P < 0.05). Re-rupture of Achilles tendon occurred in 1 case (4.3%) of minimally invasive group and limited incision group respectively; no re-rupture was found in traditional group (0), showing significant difference when compared with the other 2 groups (P < 0.05). All cases were followed up 12-18 months with an average of 14.9 months. The function of the joint was restored. The AOFAS score was more than 90 points in 3 groups at 12 months after operation, showing no significant difference among 3 groups (P > 0.05).
The above 3 procedures can be used to treat acute Achilles tendon rupture. However, minimally invasive percutaneous Achilles tendon anastomosis and Achilles tendon anastomosis limited incision have the advantages of less invasion, good healing, short hospitalization days, and less postoperative complication, and have the disadvantage of increased risk for re-rupture of Achilles tendon after operations.
比较传统开放性跟腱吻合术、微创经皮跟腱吻合术和跟腱吻合有限切开术3种方法治疗急性跟腱断裂的疗效，为临床治疗方案的选择提供参考。
2007年12月至2010年3月，采用传统开放性跟腱吻合术治疗急性跟腱断裂69例（传统组，n = 23），采用微创经皮跟腱吻合术治疗（微创组，n = 23），采用跟腱吻合有限切开术治疗（有限切开组，n = 23）。3组患者在性别、年龄、损伤机制及美国足踝外科协会（AOFAS）踝 - 后足评分方面差异无统计学意义（P > 0.05）。
微创组和有限切开组在住院天数和失血量方面明显优于传统组（P < 0.01）。传统组有2例发生切口感染，其他2组患者切口均一期愈合，并发症发生率差异有统计学意义（P < 0.05）。微创组和有限切开组分别有1例（4.3%）发生跟腱再次断裂；传统组未发现跟腱再次断裂（0），与其他2组比较差异有统计学意义（P < 0.05）。所有病例均随访12 - 18个月，平均14.9个月。关节功能恢复。术后12个月时3组AOFAS评分均大于90分，3组间差异无统计学意义（P > 0.05）。
上述3种术式均可用于治疗急性跟腱断裂。然而，微创经皮跟腱吻合术和跟腱吻合有限切开术具有创伤小、愈合好、住院天数短、术后并发症少的优点，但存在术后跟腱再次断裂风险增加的缺点。
