Sarman Hakan, Muezzinoglu Umit Sefa, Memisoglu Kaya, Aydin Adem, Atmaca Halil, Baran Tuncay, Odabas Ozgur Bahar, Ozgur Turgay, Kantar Cengizhan
Assistant Professor, Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey.
Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey.
J Foot Ankle Surg. 2016 Sep-Oct;55(5):965-70. doi: 10.1053/j.jfas.2016.04.014. Epub 2016 Jun 20.
The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes compared with open surgery.
本研究的目的是评估用于修复跟腱断裂的半侵入性“内部夹板固定”（SIIS）方法相对于采用Krakow缝合法的开放性修复术的效果。基于临床和功能结果、术后磁共振成像测量、等速测试结果以及手术并发症发生率对疗效进行评估。功能测量包括Thermann评分和美国矫形足踝协会（AOFAS）踝关节评分、双侧踝关节背屈和跖屈测量。使用磁共振成像比较每条跟腱的双侧长度和厚度。使用Biodex System 3测力计评估等速测试结果。在符合纳入标准的45例患者中，24例采用SIIS治疗，21例采用开放性Krakow缝合法治疗。所有患者的平均随访时间为43.7（范围6至116）个月。在SIIS组中，患者在7.2（范围6至8）周后恢复正常日常活动，而开放性手术组为14.3（范围12至15）周。开放性修复组的AOFAS踝关节评分为93.5（范围82至100）分，SIIS组为96.2（范围86至100）分。开放性修复组的Thermann评分为80.4（范围53至91）分，SIIS方法组为87.9（范围81至100）分。采用磁共振成像测量，开放性手术组和SIIS组患侧跟腱的平均长度分别为175.06（范围110至224）mm和177.76（范围149至214）mm。1例患者在SIIS手术后立即出现腓肠神经支配区域的感觉障碍，不过该缺陷在12个月内完全消失。根据等速测试测量结果，与开放性手术组相比，SIIS取得了更好的结果。综上所述，这些数据表明，对于跟腱断裂，SIIS方法在功能和客观结果方面均比开放性手术表现更佳。
