Leigheb Massimiliano, Guzzardi Giuseppe, Pogliacomi Francesco, Sempio Luca, Grassi Federico A
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Acta Biomed. 2017 Oct 18;88(4S):50-55. doi: 10.23750/abm.v88i4-S.6794.
Achilles tendon rupture is frequent and can result in a disabling condition. The ideal method of management remains a matter of debate. We aimed to compare the clinical outcome of patients who underwent surgical repair of Achilles tendon rupture with Silfverskiöld augmentation technique with gastrocnemius fascia flap versus Krackow end-to-end stitching technique.
We retrospectively studied all patients that were surgically treated for Achilles tendon rupture at our institution, between January 2000 and December 2015, using either Silfverskiöld or Krackow technique. We excluded all patients deceased or untreaceble, and those refusing the follow up interview. Disability, Quality-of-Life and functional restriction were evaluated using the Achilles-Tendon-total-Rupture-Score (ATRS) and Foot-and-Ankle-Disability-Index (FADI); means were compared by the Mann-Whitney test and correlations by the Spearman coefficient.
A total of 90 patients were included, with a mean age of 45.3±12.6 years. The augmented repair group-A included 33 patients and the simple repair group-B 57 patients. Follow-up averaged 8 years (1 to 16). FADI was 103.7±1.6 for group-A versus 100.3±15.6 for group-B. ATRS was 2.0±7.1 and 5.7±18.8, respecitvely. Differences were not significant. Age showed a low linear correlation with ATRS (R=0.41) and FADI (R=-0.40), indicating that clinical outcomes minimally tend to worsen in older patients.
We didn't find significative differences in the clinical outcomes between the two groups of patients. Acute uncomplicated Achilles tendon ruptures can be successfully treated with a direct suture technique. Augmentation with a fascial flap should be reserved to chronic or neglected cases with severe tendinosis or tissue defect.
跟腱断裂较为常见，可导致残疾状况。理想的治疗方法仍存在争议。我们旨在比较采用西尔弗斯基öld增强技术联合腓肠肌筋膜瓣对跟腱断裂进行手术修复的患者与采用克拉科夫端端缝合技术的患者的临床结局。
我们回顾性研究了2000年1月至2015年12月期间在我院接受跟腱断裂手术治疗的所有患者，他们采用的是西尔弗斯基öld技术或克拉科夫技术。我们排除了所有已故或无法追踪的患者，以及那些拒绝接受随访访谈的患者。使用跟腱全断裂评分（ATRS）和足踝残疾指数（FADI）评估残疾、生活质量和功能受限情况；通过曼-惠特尼检验比较均值，通过斯皮尔曼系数分析相关性。
共纳入90例患者，平均年龄45.3±12.6岁。增强修复组A包括33例患者，简单修复组B包括57例患者。随访平均8年（1至16年）。A组的FADI为103.7±1.6，B组为100.3±15.6。ATRS分别为2.0±7.1和5.7±18.8。差异无统计学意义。年龄与ATRS（R = 0.41）和FADI（R = -0.40）呈低度线性相关，表明老年患者的临床结局仅有轻微恶化趋势。
我们未发现两组患者的临床结局存在显著差异。急性非复杂性跟腱断裂可通过直接缝合技术成功治疗。筋膜瓣增强术应保留用于伴有严重肌腱病或组织缺损的慢性或被忽视的病例。
