Mohd J, Bhat N A, Lone Z A, Bhat T A, Afzal T, Dev B, Butt M F, Gupta S
Department of Orthopaedics, Government Medical College Anantnag, Anantnag, India.
Department of Orthopaedics, Government Medical College Jammu, Jammu, India.
Malays Orthop J. 2023 Jul;17(2):49-56. doi: 10.5704/MOJ.2307.008.
Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries.
This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery.
None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%).
This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.
开放性跟腱损伤较为罕见，且常伴有严重的软组织并发症。本研究的目的是评估一种简单且微创技术的临床疗效和安全性，旨在判断该技术是否有助于减少开放性跟腱损伤中皮瓣和伤口相关的并发症。
这项为期四年的前瞻性研究纳入了20例采用简单微创隧道技术治疗的开放性跟腱损伤患者。主要结局变量是严重软组织并发症的发生情况。次要结局变量包括使用美国足踝外科协会（AOFAS）踝后足评分评估的功能结局、跟腱再次断裂情况以及翻修手术需求。
本系列患者均未发生严重软组织并发症。根据AOFAS后足评分系统，19例（95%）患者取得了良好至优秀的结局。所有患者在术后6个月均能进行踮脚尖行走。所有患者均未出现跟腱再次断裂，也无患者需要进行翻修手术。所遇到的并发症包括修复部位肌腱增厚（15%）、浅表伤口感染（5%）、缝线肉芽肿（5%）和增生性瘢痕（5%）。
该技术在减少开放性跟腱损伤手术治疗相关的软组织并发症方面似乎很有前景。大多数患者最终临床结局良好。该技术安全、简单且可重复。然而，建议进一步开展更大样本量的随机对照研究来评估该技术。
