Hebei Medical University Third Affiliated Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
Hebei Province General Hospital, 384 West Heping Road, Shijiazhuang, 050000, Hebei, China.
BMC Musculoskelet Disord. 2020 Aug 26;21(1):580. doi: 10.1186/s12891-020-03588-5.
This study aimed to compare the operative outcome of percutaneous repair (modified Bunnell suture technique) versus open repair (bundle-to-bundle suture technique) of acute Achilles tendon rupture.
Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated in this prospective study. Thirty-six patients were treated using the bundle-to-bundle suture technique (group A), and 36 patients were treated using the modified Bunnell suture technique (group B). All patients underwent functional examination comprising measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides on magnetic resonance imaging. The number of single-leg heel rises (height > 5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome at 12 months postoperatively.
A total of 61 patients were followed up. The mean follow-up duration did not significantly differ between group A (23.73 ± 2.81 months) and group B (22.61 ± 3.96 months). However, there were significant differences between groups in the heel-rise test (group A, 1.74 ± 0.96; group B, 2.37 ± 1.42) and length of the Achilles tendon (group A, 11.98 ± 1.64 cm; group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in group A than in group B (p = 0.043). The cross-sectional diameter of the Achilles tendon was significantly smaller in group A than group B. At final follow-up, there were no significant differences between the two groups in the ATRS, AOFAS score, or VAS score. One patient in group A had delayed wound healing, which resolved in 40 days.
Patients with acute Achilles tendon rupture treated with open repair (bundle-to-bundle suture technique) achieved a better clinical outcome regarding the heel-rise test and calf circumference compared with those treated with percutaneous repair (modified Bunnell suture technique).
Chinese Clinical Trial Registry, ChiCTR2000035229 , 8/4/2020, Retrospectively registered.
本研究旨在比较经皮修复（改良 Bunnell 缝合技术）与切开修复（束带对束带缝合技术）治疗急性跟腱断裂的手术效果。
本前瞻性研究共评估了 72 例连续接受跟腱断裂手术治疗的患者。36 例患者采用束带对束带缝合技术（A 组）治疗，36 例患者采用改良 Bunnell 缝合技术（B 组）治疗。所有患者均接受功能检查，包括测量小腿周径和单腿足跟抬高试验。磁共振成像比较患侧和健侧跟腱的长度和直径。比较患侧和健侧 15 秒内单腿足跟抬高次数（高度>5cm）。记录踝关节活动范围。术后 12 个月采用跟腱总断裂评分（ATRS）、美国矫形足踝协会（AOFAS）踝关节-后足评分和视觉模拟评分（VAS）评估临床疗效。
共有 61 例患者获得随访。A 组（23.73±2.81 个月）和 B 组（22.61±3.96 个月）的平均随访时间无显著差异。然而，两组足跟抬高试验（A 组，1.74±0.96；B 组，2.37±1.42）和跟腱长度（A 组，11.98±1.64cm；B 组，11.11±1.74cm）存在显著差异。A 组患侧小腿周径明显大于 B 组（p=0.043）。A 组跟腱横截面积明显小于 B 组。末次随访时，两组 ATRS、AOFAS 评分和 VAS 评分无显著差异。A 组 1 例患者发生延迟愈合，40 天愈合。
与经皮修复（改良 Bunnell 缝合技术）相比，切开修复（束带对束带缝合技术）治疗急性跟腱断裂患者在足跟抬高试验和小腿周径方面获得更好的临床效果。
中国临床试验注册中心，ChiCTR2000035229，2020 年 8 月 4 日，回顾性注册。
