Liu Jun-Yi, Duan Wei-Feng, Shen Sheng, Ye Ye, Sun Yong-Qiang, He Wei
First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
Orthopedic Trauma Center, Orthopedic Hospital of Henan Province, Zhengzhou, China.
J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(1):2309499020908354. doi: 10.1177/2309499020908354.
To date, the best treatment of acute Achilles tendon rupture (AATR) is still inconclusive. Achillon seems to be a promising approach with satisfactory function and low complication rate. We hypothesize a modified minimally invasive repair (MMIR), which provides direct visualization of proximal tendon stump without specialized equipment that could provide comparable results. This trial is aimed to evaluate the functional and surgical outcomes of MMIR comparing with Achillon.
From February 2013 to February 2017, 114 patients with AATR were enrolled in this trial, underwent an alternative operation (Achillon or MMIR), and accelerated rehabilitation protocol. Forty-four patients took the Achillon and the other 70 patients took the MMIR at their subjective choice. One hundred eleven full follow-up data were obtained including Achilles tendon total rupture score (ATRS), time back to work, rerupture rate, overall complication rate, and operation time.
There was no significant difference between groups in demographic characters. There was no statistical difference between both groups regarding to time return to work and ATRS at 3rd, 6th, 12th, and 24th month, respectively. Five reruptures and two Achilles tendons tethering to skins were found in the Achillon group, and two reruptures and one sural nerve injury in the MMIR group. No wound infection and dehiscence occurred. Overall complication rate in the Achillon group is higher (16.3% vs. 4.4%, = 0.044). The operation time of Achillon is less than MMIR (34.84 vs. 39.71, < 0.001).
Both techniques combining with accelerated rehabilitation showed to be reliable and effective. MMIR is safer and more economical, and Achillon is faster.
迄今为止，急性跟腱断裂（AATR）的最佳治疗方法仍无定论。Achillon似乎是一种很有前景的方法，功能良好且并发症发生率低。我们设想一种改良的微创修复术（MMIR），无需专门设备就能直接观察近端肌腱残端，且能取得类似的效果。本试验旨在评估MMIR与Achillon相比的功能和手术效果。
2013年2月至2017年2月，114例AATR患者纳入本试验，接受了替代手术（Achillon或MMIR）及加速康复方案。44例患者自主选择采用Achillon，另外70例患者采用MMIR。获得了111份完整的随访数据，包括跟腱总断裂评分（ATRS）、恢复工作时间、再断裂率、总体并发症发生率及手术时间。
两组患者在人口统计学特征方面无显著差异。两组在第3、6、12和24个月恢复工作时间及ATRS方面分别无统计学差异。Achillon组发现5例再断裂和2例跟腱与皮肤粘连，MMIR组发现2例再断裂和1例腓肠神经损伤。未发生伤口感染和裂开。Achillon组总体并发症发生率更高（16.3%对4.4%，P = 0.044）。Achillon的手术时间比MMIR短（34.84对39.71，P < 0.001）。
两种技术结合加速康复均显示可靠且有效。MMIR更安全、更经济，而Achillon更快。
