一种新型微创手术联合早期运动疗法促进肌腱再生治疗自发性跟腱断裂。
A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture.
作者信息
Aisaiding Amuding, Wang Jianping, Maimaiti Rouziwanguli, Jialihasi Ayidaer, Aibek Rakimbaiev, Qianman Bayixiati, Shawutali Nuerai, Badelihan Ayinazi, Bahetiya Wulan, Kubai Aliya, Kelamu Mailamuguli, Nuerdoula Yeermike, Makemutibieke Elihaer, Bakyt Yerzat, Wuerliebieke Jianati, Jielile Jiasharete
机构信息
Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China.
Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China.
出版信息
Injury. 2018 Mar;49(3):712-719. doi: 10.1016/j.injury.2017.10.046. Epub 2017 Oct 31.
OBJECTIVE
Acute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture.
METHODS
Fifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography.
RESULTS
Mean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients.
CONCLUSIONS
The novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.
目的
急性闭合性自发性跟腱断裂常发生于老年人，且通常伴有多种并发症。传统的手术方法用于切除肌腱病变和跟腱附着点骨赘，创伤性大且会引发并发症。在本研究中，对先前建立的微创手术方法进行了改良，并结合哈萨克族运动疗法，以减少创伤、促进伤口愈合，并在急性闭合性自发性跟腱断裂的治疗中促进肌腱再生。
方法
52例急性闭合性自发性跟腱断裂患者被随机分为两组。A组包括23例采用新方法治疗的患者。B组包括29例采用连续内侧斜行手术方法治疗的患者。在术后12周、24周及2年进行随访检查。通过跟腱断裂评分（ATRS）、足跟抬高耐力试验以及超声和多层螺旋计算机断层扫描评估结果。
结果
A组术后12周和24周的平均ATRS分别为68.6和86.0，显著高于B组（分别为55.9和72.0）。与B组相比，A组患者的恢复情况明显更好（p<0.01），使他们能够参与早期康复运动疗法。A组患者术后很少出现感染和跟腱外露等并发症，而B组伤口愈合较慢，内侧皮瓣易发生坏死和感染，10%的患者出现跟腱外露。
结论
新型微创手术在治疗急性闭合性自发性跟腱断裂方面比以往方法更具优势，可促进伤口愈合和肌腱再生。
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