Department of Orthopaedics, Lanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu Province, Lanzhou, China.
Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
Orthop Surg. 2023 Feb;15(2):517-524. doi: 10.1111/os.13615. Epub 2022 Dec 26.
Percutaneous suture is a classic technique used in Achilles tendon repair. However, the complication rates surrounding the sural nerve remain relatively high. Modified percutaneous repair technology can effectively avoid these complications; however, the surgical procedure is complicated. Hence, the present study was conducted to describe a redesigned repair technique for the Achilles tendon able to avoid sural nerve injury and reduce the complexity of the procedure.
Data of patients with acute primary Achilles tendon rupture at our hospital from January 2019 to May 2020 were included. Subjects with expectations for surgical scarring underwent a minimally invasive-combined percutaneous puncture technique. The surgical time, requirement for conversion to other technologies, and length of postoperative hospitalization were investigated to assess efficacy. The American Orthopedic Foot & Ankle Society (AOFAS) score and the Arner-Lindholm scale (A-L scale) were used to assess postoperative clinical outcomes (> 24 months). During the 2-year follow-up, MRI was performed to observe the healing of the Achilles tendon. In addition, subjective satisfaction with surgical scar healing was recorded.
Twenty consecutive subjects with an average follow-up of 28.3 ± 4.5 months (range, 24-41) met the inclusion criteria. None of the 20 enrolled patients required a converted surgical approach. The mean surgical time was 26.9 ± 6.47 min (range, 20-44). None of the patients experienced dysesthesia or anesthesia around the sural nerve. No signs of postoperative infections were observed. MRI data showed that the wounds of the Achilles tendon healed completely in all the subjects. The AOFAS score increased from 55.6 ± 11.07 (range, 28-71) preoperatively to 97.8 ± 3.34 (range, 87-100) at the last follow-up. The A-L scale showed that 90% of the subjects (n = 18) presented as excellent and 10% of the subjects (n = 2) presented as good, with an excellent/good rate of 100%. Moreover, subjects' satisfaction for surgical scars was 9.1 ± 0.78 (upper limit, 10).
The results indicate that this technique can achieve good postoperative function, a small surgical incision, and high scar satisfaction. In addition, this technique should be widely used in suturing Achilles tendon ruptures.
经皮缝合是修复跟腱断裂的经典技术。然而，跟腱周围的腓肠神经并发症发生率仍然相对较高。改良经皮修复技术可有效避免这些并发症，但手术过程复杂。因此，本研究旨在介绍一种新的跟腱修复技术，可避免腓肠神经损伤并降低手术复杂性。
纳入我院 2019 年 1 月至 2020 年 5 月急性原发性跟腱断裂患者的临床资料。对预期有手术瘢痕的患者采用微创联合经皮穿刺技术。评估手术时间、是否需要转换为其他技术以及术后住院时间，以评估疗效。采用美国矫形足踝协会（AOFAS）评分和 Arner-Lindholm 量表（A-L 量表）评估术后临床结果（>24 个月）。在 2 年随访期间，通过 MRI 观察跟腱愈合情况。此外，记录患者对手术瘢痕愈合的主观满意度。
连续纳入 20 例患者，平均随访 28.3±4.5 个月（24-41 个月），均符合纳入标准。20 例患者均无需转换手术方式。手术时间平均为 26.9±6.47 分钟（20-44 分钟）。所有患者均未出现腓肠神经感觉异常或麻木。无术后感染征象。MRI 数据显示所有患者跟腱伤口均完全愈合。AOFAS 评分由术前的 55.6±11.07（28-71 分）增加至末次随访时的 97.8±3.34（87-100 分）。A-L 量表显示，90%（18 例）患者为优，10%（2 例）患者为良，优良率为 100%。此外，患者对手术瘢痕的满意度为 9.1±0.78（满分 10）。
该技术可获得良好的术后功能、较小的手术切口和较高的瘢痕满意度。此外，该技术应广泛应用于跟腱断裂缝合。
