Zwipp H, Südkamp N, Thermann H, Samek N
Unfallchirurg. 1989 Nov;92(11):554-9.
From 1972 to 1980, 153 patients with acute rupture of the Achilles tendon were treated operatively in the Trauma Department of Hannover Medical School, 127 of whom were assessed postoperatively according to the Trillat scale at an average of 9.8 years after injury. Consideration of the tendon ruptures showed that 80% had occurred during sports activities, 86% were in males, and the highest incidence was in the age group 31-40 years (45%). In 67% an indirect trauma was present, and 35% of the patients had a history of antecedent pain and discomfort. In 77 patients the tendon was examined histologically within 24 h of injury. There was no histological evidence of antecedent pathology or degenerative condition in those cases with direct/indirect trauma, whereas in 11 of 13 cases without a history of trauma degenerative changes were observed. The operative procedure of the primary simple end-to-end suture with absorbable material showed fewer wound complications (8.4%) than were seen in the other group, in which non-absorbable sutures were used or secondary reconstructive procedures applied (3 of 8). The results obtained with primary operative tendon suturing were evaluated according to the Trillat scale as excellent in 68.8%; as good, in 20.8%; as satisfactory in 8.8%; and as poor in 1.6%. During a 10-year follow-up after primary tendon suture rerupture occurred in 2% of cases.
1972年至1980年期间,汉诺威医学院创伤科对153例急性跟腱断裂患者进行了手术治疗,其中127例在受伤后平均9.8年时根据Trillat评分进行了术后评估。对这些跟腱断裂情况的分析显示,80%发生在体育活动期间,86%为男性,发病率最高的年龄组为31 - 40岁(45%)。67%存在间接创伤,35%的患者有先前疼痛和不适的病史。77例患者在受伤后24小时内进行了肌腱组织学检查。在直接/间接创伤的病例中,没有先前病理或退行性病变的组织学证据,而在13例无创伤史的病例中,有11例观察到退行性改变。采用可吸收材料进行一期单纯端端缝合的手术操作,伤口并发症较少(8.4%),而在使用不可吸收缝线或进行二期重建手术的另一组中(8例中的3例),并发症较多。根据Trillat评分,一期手术肌腱缝合的结果评估为:优,68.8%;良,20.8%;满意,8.8%;差,1.6%。在一期肌腱缝合后的10年随访期间,2%的病例发生了再断裂。