Bevoni R, Angelini A, D'Apote G, Berti L, Fusaro I, Ellis S, Schuh R, Girolami M
Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy.
Department of Orthopaedic Surgery, University of Bologna, Istituto Ortopedico Rizzoli, Italy.
Injury. 2014 Aug;45(8):1268-74. doi: 10.1016/j.injury.2014.04.028. Epub 2014 Apr 28.
The best treatment for acute rupture of the Achilles tendon is still under debate. Our purpose was to evaluate surgical triple-bundle technique in selected patients with full subcutaneous rupture of Achilles tendon.
Sixty-six consecutive patients (56 men, 10 women; age range 20-61 years) with full unilateral rupture of the Achilles tendon were surgically treated by the triple-bundle technique. Seventy-four percent of the lesions occurred during sport activity. Each patient was assessed by: (1) The American Orthopaedic Foot and Ankle Society (AOFAS) score; (2) the Leppilahti score; (3) the range of movement measurement of ankle joint; (4) ipsilateral thigh, calf, and ankle circumferences compared to the contralateral limb; (5) functional evaluation with isokinetic dynamometry of both limbs.
80.3% of the patients were fully satisfied (AOFAS ≥90) with treatment and resumed their previous level of sport. Concerning the outcomes, (1) the mean AOFAS score at 36 months was 93.9; (2) the mean Leppilahti score at 36 months was 91.8; (3) the mean difference in dorsiflexion and plantarflexion between the healthy side and the operated side was 4.3° and 6.9°, respectively. We observed calf muscle hypotrophy in two cases and scar complication in one. No re-ruptures occurred. Isokinetic tests performed 36 months after surgery showed a good restoration of plantarflexion. At univariate analysis AOFAS was influenced by age and difference between the healthy side and the operated side in dorsiflexion, plantarflexion, and circumference at all three levels and strenght at 60°/s. At univariate analysis, Leppilahti score confirmed the significant parameters of the AOFAS with the exception of age and difference of thigh circumference. The only predictive parameters in multivariate analysis were dorsiflexion difference (O.R. = 0.831; 95% C.I. 0.694-0.995; p = 0.044) and plantarflexion difference (O.R. = 0.777; 95% C.I. 0.631-0.958; p = 0.018).
In this case series the triple-bundle technique showed a low rate of complications and good functional restore tested with isokinetic tests. For these reasons afforded by biomechanical strength test reported in literature, this technique has to be considered a valid choice for the treatment of Achilles tendon rupture in young patients with a high level of sport activity.
跟腱急性断裂的最佳治疗方法仍存在争议。我们的目的是评估手术三束技术在选定的完全皮下跟腱断裂患者中的应用。
连续66例（56例男性，10例女性；年龄范围20 - 61岁）单侧跟腱完全断裂患者接受了三束技术手术治疗。74%的损伤发生在体育活动期间。对每位患者进行以下评估：（1）美国矫形足踝协会（AOFAS）评分；（2）莱皮拉hti评分；（3）踝关节活动度测量；（4）与对侧肢体相比，患侧大腿、小腿和踝关节的周长；（5）通过双下肢等速测力进行功能评估。
80.3%的患者对治疗完全满意（AOFAS≥90），并恢复到之前的运动水平。关于治疗结果，（1）36个月时的平均AOFAS评分为93.9；（2）36个月时的平均莱皮拉hti评分为91.8；（3）健侧与手术侧背屈和跖屈的平均差异分别为4.3°和6.9°。我们观察到2例出现小腿肌肉萎缩，1例出现瘢痕并发症。未发生再断裂。术后36个月进行的等速测试显示跖屈功能恢复良好。单因素分析显示，AOFAS受年龄以及健侧与手术侧在三个水平的背屈、跖屈和周长差异以及60°/s时的力量影响。单因素分析中，莱皮拉hti评分证实了AOFAS的显著参数，但年龄和大腿周长差异除外。多因素分析中唯一的预测参数是背屈差异（比值比 = 0.831；95%可信区间0.694 - 0.995；p = 0.044）和跖屈差异（比值比 = 0.777；95%可信区间0.631 - 0.958；p = 0.018）。
在这个病例系列中，三束技术显示出低并发症发生率，并且通过等速测试显示功能恢复良好。基于文献报道的生物力学强度测试结果，对于运动水平较高的年轻跟腱断裂患者，该技术应被视为一种有效的治疗选择。
