摘要
目的比较急性闭合性跟腱断裂患者采用微创横切口卵圆钳辅助穿针缝合与微创小切口改良缝合法的疗效差异,为跟腱断裂的个体化治疗提供依据。方法采用前瞻性随机对照研究。选取2021年1月至2024年1月就诊于沧州市人民医院的急性闭合性跟腱断裂患者120例,根据随机数字表法分为A组和B组,各60例,分别采用微创横切口卵圆钳辅助穿针缝合和微创小切口改良缝合。比较两组患者术中出血量、切口长度、下地行走时间、住院天数、手术耗时、踝关节背屈活动度、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)制定的踝与后足功能评分(ankle-hindfoot scale,AHS)和踝关节功能差异。结果两组完全负重活动时间、住院天数比较无统计学差异(P>0.05);A组术中出血量、切口长度、手术耗时低于B组,术后至首次下地行走时间长于B组(P<0.05);术后3个月时,两组患者主动和被动背屈活动度、疼痛、功能、足部对线及总分均高于本组术前(P<0.05);A组被动背屈活动度、疼痛、功能及AOFAS-AHS总分高于B组(P<0.05);两组足部对线评分比较无统计学差异(P>0.05)。术后6个月进行末次随访,两组患者均能够正常行走,且负重行走有力,经跟腱完全断裂评分问卷可知,两组患者踝关节功能均处于优良状态,组间优良率比较无差异(P>0.05)。结论微创横切口卵圆钳辅助穿针缝合法在减少术中出血、切口长度和手术耗时方面优于微创小切口改良缝合法,且术后3个月功能恢复更佳。两种方法在足部对线和6个月踝关节功能优良率方面无显著差异,均有效,但前者恢复更快。
Objective To compare the efficacy of minimally invasive transverse incision with ovoid clamp-assisted needle passage suture with the minimally invasive modified suture technique for the treatment of acute closed traumatic Achilles tendon rupture.Methods A prospective randomized controlled study was used.A total of 120 patients with acute closed Achilles tendon rupture who were admitted to Cangzhou People's Hospital from January 2021 to January 2024 were selected.According to the random number table method,the patients were divided into Group A and Group B,with 60 cases in each group.Group A was treated with minimally invasive transverse incision combined with ovoid clamp-assisted needle passage suture,while Group B was treated with minimally invasive small incision modified suture technique.The following indicators were compared between the two groups:intraoperative blood loss,incision length,time to ambulation(ability to walk on the ground),length of hospital stay,operation duration,ankle dorsiflexion range of motion,the Ankle-Hindfoot Scale(AHS)developed by the American Orthopaedic Foot and Ankle Society(AOFAS),and differences in ankle joint function.Results There was no significant difference in the time to full weight-bearing activity or length of hospital stay between the two groups(P>0.05).Compared with Group B,Group A had less intraoperative blood loss,a shorter incision length,and a shorter operation duration,while the time from surgery to first ambulation(ability to walk on the ground)was longer in Group A(P<0.05).At 3 months postoperatively,the active and passive dorsiflexion range of motion,pain score,function score,foot alignment score,and total score of both groups were significantly higher than those in the same group before surgery(P<0.05).Specifically,Group A showed higher values in passive dorsiflexion range of motion,pain score,function score,and total score of AOFAS-AHS compared with Group B(P<0.05),while no significant difference was observed in the foot alignment score between the two groups(P>0.05).The last follow-up was conducted at 6 months postoperatively.All patients in both groups were able to walk normally with strong weight-bearing capacity.According to the Achilles Tendon Complete Rupture Scoring Questionnaire,the ankle joint function of patients in both groups was classified,and there was no significant difference in the excellent-good rate between the two groups(P>0.05).Conclusion The minimally invasive transverse incision with ovoid clamp-assisted needle passage suture is superior to the minimally invasive small incision modified suture technique in reducing intraoperative blood loss,shortening incision length and operation duration,and achieves better functional recovery at 3 months postoperatively.There are no significant differences between the two techniques in terms of foot alignment and the excellent-good rate of ankle joint function at 6 months postoperatively,and both are effective.However,the former enables faster recovery.
作者
朱慧颖
孙宁宁
齐巍巍
ZHU Huiying;SUN Ningning;QI Weiwei(Department of Hand and Foot Surgery,Cangzhou People's Hospital,Cangzhou061000,Hebei,China;Department of Neurosurgery,Cangzhou People's Hospital,Cangzhou 061000,Hebei,China;Pre-hospital Emergency,Cangzhou People's Hospital,Cangzhou 061000,Hebei,China)
出处
《中国现代手术学杂志》
2025年第5期392-398,共7页
Chinese Journal of Modern Operative Surgery
基金
2022年度河北省医学科学研究课题计划(20220328)。
关键词
急性闭合性跟腱断裂
缝合
疗效
微创
acute closed Achilles tendon rupture
suture
efficacy
minimally invasive
