Cetti R, Henriksen L O, Jacobsen K S
Department of Orthopaedic Surgery, Bispebjerg University Hospital, Copenhage, Denmark.
Clin Orthop Relat Res. 1994 Nov(308):155-65.
Sixty patients with acute rupture of the Achilles tendon were included in a prospective study and assigned randomly for operative treatment using a 4-string suture with either a new mobile cast (30) or a rigid below-knee cast (30). All patients were evaluated clinically for 1 year after surgery. During surgery, a radiographic monitor was placed in the Achilles tendon above and beneath the site of rupture. Radiographic evaluation of tendon behavior during healing was also performed on all patients for 1 year. Major complications were 1 rerupture in the mobile cast group and 2 reruptures and 1 infection in the rigid cast group. There were fewer minor complications in the mobile cast group. More patients in the mobile cast group resumed sports activities at the same level as before the rupture than in the rigid cast group. They also had better recovery of normal ankle movement plus faster and better recovery of plantar flexion strength. Fewer patients in the mobile cast group had calf atrophy, and fewer had problems 1 year after the accident. Furthermore, patients treated with the mobile cast had a statistically significant shorter sick leave. Radiographic evaluation of the tendon monitor showed significantly less elongation of the tendon 1 year after rupture for patients in the mobile cast group. Operative treatment with a 4-string suture and use of a postoperative mobile cast proved safe and convenient and preferable to treatment with the traditional rigid below-knee cast.
60例急性跟腱断裂患者纳入一项前瞻性研究，并随机分配接受使用4股缝线缝合并搭配新型可移动石膏（30例）或传统硬式膝下石膏（30例）的手术治疗。所有患者术后均接受了为期1年的临床评估。手术过程中，在跟腱断裂部位的上方和下方放置了影像学监测装置。所有患者在愈合过程中也接受了为期1年的跟腱影像学评估。主要并发症方面，可移动石膏组有1例再次断裂，硬式石膏组有2例再次断裂和1例感染。可移动石膏组的轻微并发症较少。与硬式石膏组相比，可移动石膏组中有更多患者恢复到了与断裂前相同水平的体育活动。他们在正常踝关节活动恢复方面也更好，跖屈力量恢复得更快且更好。可移动石膏组中出现小腿萎缩的患者较少，事故发生1年后出现问题的患者也较少。此外，使用可移动石膏治疗的患者病假时间在统计学上显著更短。对跟腱监测装置的影像学评估显示，可移动石膏组患者在断裂1年后跟腱的伸长明显更少。使用4股缝线缝合并搭配术后可移动石膏的手术治疗被证明是安全、便捷的，且优于传统的硬式膝下石膏治疗。
