Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA.
Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Surgery and Dentistry, Salerno, Italy; Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK; School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK.
J Foot Ankle Surg. 2021 Sep-Oct;60(5):935-940. doi: 10.1053/j.jfas.2021.01.009. Epub 2021 Mar 31.
We report on the outcome of acute Achilles tendon ruptures by a single surgeon using open and percutaneous techniques was performed. This prospective study included 186 patients with 188 ruptured Achilles tendons. A traditional open technique was primarily performed on patients from January 2001 to December 2011. From January 2012 to January 2018, a percutaneous repair was primarily performed. Outcome measures included the Roles and Maudsley (RM) score, ability to perform a single leg heel raise, calf atrophy and return to activity. There were 149 males (average age 42.5 ± 12.7 years) and 39 females (average age 41.7 ± 11.4 years). Of the 188 ruptured tendons (92 repairs on the right Achilles and 96 on the left), 103 were repaired percutaneously and 85 had open repairs. There were 18 (9.6%) complications. Three re-ruptures occurred, one following open and two following percutaneous repairs, all within 12 weeks of the original repair. Two patients developed a Venousthromboembolism (1.0%). Thirteen patients had suture reactions; three infections (1.6%), 11 wound complications (5.8%), and 3 required surgical excision of the suture material (1.6%). Non-absorbable sutures were associated with more wound complications and were more frequently used in open repairs (p = .003). Patients who underwent open repair experienced more wound complications (p = .0001). Patients who underwent percutaneous repair using absorbable suture experienced a lower rate of overall complications (p = .0007). Basketball (n = 29) was the most common sport during which ruptures occurred. Return to activity (RTA) was 8.2 ± 2.9 months. There was no difference for RTA between males and females (p = .54) and RM scores (p= .69), nor surgical technique, and no difference for RTA based on the desired activity (p = .47). 123 of the 188 patients returned to their desired activity (65.5%). There was a statistically significant evidence of a positive association between inability to perform heel-raises and decreased activity (p = .01).
我们报告了一位外科医生采用开放和经皮技术治疗急性跟腱断裂的结果。这项前瞻性研究纳入了 186 例 188 例跟腱断裂患者。2001 年 1 月至 2011 年 12 月，主要采用传统的开放技术治疗患者。从 2012 年 1 月至 2018 年 1 月，主要采用经皮修复术。主要观察指标包括Roles 和 Maudsley（RM）评分、单腿提踵能力、小腿萎缩和恢复活动情况。149 例为男性（平均年龄 42.5 ± 12.7 岁），39 例为女性（平均年龄 41.7 ± 11.4 岁）。188 例断裂的肌腱中（右跟腱 92 例，左跟腱 96 例），103 例行经皮修复，85 例行开放修复。共发生 18 例（9.6%）并发症。3 例再断裂，其中 1 例为开放修复后，2 例为经皮修复后，均在原始修复后 12 周内发生。2 例患者发生静脉血栓栓塞（1.0%）。13 例患者出现缝线反应；3 例感染（1.6%），11 例伤口并发症（5.8%），3 例需要手术切除缝线材料（1.6%）。不可吸收缝线与更多的伤口并发症相关，且更常用于开放修复（p =.003）。行开放修复的患者伤口并发症更多（p = .0001）。使用可吸收缝线的经皮修复患者总体并发症发生率较低（p = .0007）。篮球（n = 29）是最常见的运动，也是最容易发生断裂的运动。恢复活动（RTA）为 8.2 ± 2.9 个月。男性和女性的 RTA 之间没有差异（p =.54），RM 评分之间也没有差异（p=.69），手术技术之间也没有差异，基于期望的活动，RTA 之间也没有差异（p =.47）。188 例患者中有 123 例恢复到期望的活动水平（65.5%）。无法进行提踵与活动减少之间存在显著的正相关关系（p = .01）。
