Gedam Prashant N, Rushnaiwala Faizaan M
Department of Orthopaedics, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, India.
Department of Orthopaedics, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, India
Foot Ankle Int. 2016 Dec;37(12):1333-1342. doi: 10.1177/1071100716666365. Epub 2016 Sep 20.
The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results.
Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion.
The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage.
All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications.
Level III, retrospective comparative study.
本研究的目的是报告一种新型微创跟腱重建技术的结果，并评估围手术期发病率、中长期疗效和功能结果。
我们的系列研究包括14例患者（11例男性和3例女性），手术时的平均年龄为45.6岁。每位患者均为慢性跟腱断裂。从断裂到手术的平均间隔时间为5.5个月（范围为2 - 10个月）。平均总随访时间为30.1个月（范围为12 - 78个月）。所有患者均采用中心翻转皮瓣加游离半腱肌腱移植及经皮缝线，在内镜辅助下以微创方法进行手术。通过临床检查、美国矫形足踝协会（AOFAS）踝与后足评分以及跟腱完全断裂评分（ATRS）对患者进行回顾性评估。采用配对t检验评估术前和术后的AOFAS评分、ATRS评分以及踝关节活动范围。
缺损长度范围为3至8厘米（平均5.1厘米），而翻转皮瓣长度范围为8至13厘米（平均10.1厘米）。AOFAS平均评分从术前的64.5分提高到最后随访时的96.9分。ATRS平均评分从术前的49.4分提高到最后随访时的91.4分。所有患者均未发生伤口并发症。没有患者出现再断裂或腓肠神经损伤。
我们研究中的所有患者均取得了良好的疗效，且无并发症。我们认为，通过这种三重修复技术，可以实现与开放手术一样强大而稳固的修复，同时降低并发症的发生率。
III级，回顾性比较研究。
