Greenhagen Robert M, Shinabarger Andrew B, Pearson Kyle T, Burns Patrick R
Foot and Ankle Center of Nebraska, Omaha, NE, USA.
Foot Ankle Spec. 2013 Jun;6(3):185-90. doi: 10.1177/1938640012473150. Epub 2013 Jan 24.
Insertional Achilles tendinopathy is a problem frequently encountered by the foot and ankle surgeon. Conservative care yields mixed results, and this condition is often treated surgically. Our hypothesis is that the suture bridge technique through a central posterior incision allows adequate visualization for thorough debridement and exostectomy and provides a stable tendon-to-bone interface for healing.
The medical records of 35 patients who underwent surgical treatment for insertional Achilles tendinopathy with the suture bridge technique, by a single surgeon, between 2006 and 2012 were retrospectively reviewed. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instruments as well as a subjective questionnaire were utilized.
In all, 30 individuals who met the inclusion criteria for the treatment of insertional Achilles tendinopathy were evaluated at a mean follow-up of 28.93 ± 16.99 months. We included 10 men and 20 women, with a mean age of 49.1 ± 9.2 years. The mean preoperative AOFAS score was 56.6 ± 14.0. The average postoperative AOFAS score significantly increased to 91.7 ± 10.4 (P < .0001). One participant required revisional surgery, consisting of a flexor hallucis longus transfer performed by another physician. There were no wound complications or infections. Overall, there was a 97% (28/29) satisfaction rate.
The central incision with complete detachment of the Achilles tendon and reattachment with the suture bridge technique for the treatment of insertional Achilles tendinopathy provides an effective treatment with good to excellent clinical outcomes in 97% of patients, with a mean follow-up of 29 months.
跟腱止点性腱病是足踝外科医生经常遇到的问题。保守治疗效果不一，这种情况通常采用手术治疗。我们的假设是，通过后正中切口的缝线桥技术能够提供充分的视野，便于彻底清创和切除骨赘，并为愈合提供稳定的腱-骨界面。
回顾性分析2006年至2012年间由同一位外科医生采用缝线桥技术对35例跟腱止点性腱病患者进行手术治疗的病历。使用美国矫形足踝协会（AOFAS）后足评分工具以及一份主观问卷。
共有30例符合跟腱止点性腱病治疗纳入标准的患者接受评估，平均随访时间为28.93±16.99个月。其中男性10例，女性20例，平均年龄49.1±9.2岁。术前AOFAS平均评分为56.6±14.0。术后AOFAS平均评分显著提高至91.7±10.4（P<.0001）。1例患者需要再次手术，由另一位医生进行了踇长屈肌转移术。未出现伤口并发症或感染。总体满意度为97%（28/29）。
采用跟腱完全切断并通过缝线桥技术重新附着的后正中切口治疗跟腱止点性腱病，在平均随访29个月时，97%的患者获得了良好至优秀的临床效果，是一种有效的治疗方法。
