Baindoor Prasanna, Gumaste Abhishek, Jeevannavar Santosh, Shenoy Keshav, Kumar Sachin
Department of Orthopaedics, SDM Medical College and Hospital, SDM University, Dharwad, Karnataka State, India.
J Clin Orthop Trauma. 2020 Jul 14;14:132-138. doi: 10.1016/j.jcot.2020.06.033. eCollection 2021 Mar.
Open injuries of the Tendoachilles present a challenge to the treating surgeon. Although, common in our setting, there is a paucity of literature regarding management of the same. The purpose of this retrospective study was to analyse the functional outcomes following debridement and primary repair of open tears of the Tendoachilles.
Patients with open tears of the tendoachilles, between January 2012 to January 2017. After obtaining demographic data, including mechanism of injury, all patients were managed by adequate debridement and primary repair, by Pennington's modification of Kessler's technique in a single sitting, paratenon closed circumferentially, plantaris reinforcement used when end to end repair couldn't be achieved. Below knee cast for 2 months. Weight bearing started at three months. Statistical analysis using paired -test for calf circumference, ankle range of motion comparing with uninjured limb. Functional outcome assessment by AOFAS hindfoot score and Achilles tendon rupture score.
23 male patients, mean age 35, were analysed. Field injury was the most common mechanism, with slip in Indian lavatory pans accounting for four patients. Average time to surgery from injury was 22 hours. Plantaris reinforcement in one case. No case of wound dehiscence, scar adherence, tendon rerupture or infection. One patient had serous discharge at three weeks which settled with oral antibiotics. 21 patients performed single heel raise. There was no significant difference in calf circumference and ankle range of motion compared to uninjured limb. Mean AOFAS score was 92, mean Achilles tendon rupture score 77.
Though open injuries of the tendoachilles is fraught with complications, early debridement, adequate repair of the tendon edges with circumferential closure of the paratenon, yields adequate functional outcomes with minimal complications.
跟腱开放性损伤给外科治疗医生带来了挑战。尽管在我们的医疗环境中很常见，但关于其治疗的文献却很少。这项回顾性研究的目的是分析跟腱开放性撕裂清创及一期修复后的功能结果。
选取2012年1月至2017年1月期间跟腱开放性撕裂的患者。获取包括损伤机制在内的人口统计学数据后，所有患者均接受了充分的清创和一期修复，采用彭宁顿改良的凯斯勒技术一次性完成，腱周组织环形闭合，若无法进行端端修复则采用跖肌腱加强。膝关节以下石膏固定2个月。3个月开始负重。采用配对t检验对小腿周径、踝关节活动范围与未受伤肢体进行统计学分析。通过美国足踝外科协会（AOFAS）后足评分和跟腱断裂评分评估功能结果。
分析了23例男性患者，平均年龄35岁。野外损伤是最常见的损伤机制，4例患者因在印度马桶上滑倒受伤。受伤至手术的平均时间为22小时。1例采用跖肌腱加强。无伤口裂开、瘢痕粘连、肌腱再次断裂或感染病例。1例患者在3周时出现浆液性渗出，口服抗生素后好转。21例患者能够单脚提踵。与未受伤肢体相比，小腿周径和踝关节活动范围无显著差异。平均AOFAS评分为92分，平均跟腱断裂评分为77分。
尽管跟腱开放性损伤并发症较多，但早期清创、对肌腱边缘进行充分修复并环形闭合腱周组织，可获得良好的功能结果，并发症最少。
