跟腱断端瘢痕组织修复在陈旧性跟腱断裂治疗中的应用

doi:10.3760/cma.j.cn101202-20220614-00185

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摘要目的探讨修复跟腱断端瘢痕组织治疗陈旧性跟腱断裂的临床疗效。方法横断面研究。纳入2018年8月—2021年7月中国科学技术大学附属第一医院收治的21例陈旧性跟腱断裂患者的临床资料。其中男17例,女4例;年龄20~73（43.5±16.0）岁;右侧11例,左侧10例;患者均采用修复跟腱断端瘢痕组织治疗陈旧性跟腱断裂。记录手术时间、切口长度、术后并发症,以及日常活动、运动恢复时间;比较术前与术后末次随访时美国足踝外科协会（AOFAS）的踝-后足评分、疼痛视觉模拟评分法（VAS）评分;记录末次随访时患者跟腱完全断裂评分（ATRS）、Arner-Lindholm评分、单足提踵试验结果。结果本组患者手术时间30~50 min（平均41.1 min）,手术切口4~7 cm（平均5.6 cm）;术后无感染、腓肠神经损伤和再破裂等严重并发症出现。所有患者术后获6~40个月（平均18.5个月）的随访。患者术后恢复日常活动时间（4.4±0.7）个月、恢复运动时间（11.1±1.5）个月。AOFAS的踝-后足评分由术前（63.5±6.9）分提高至末次随访的（89.9±4.8）分,疼痛VAS评分由术前4（3,4）分降低至末次随访的0（0,1）,差异均有统计学意义（t=-14.45、Z=5.69,P值均<0.001）。末次随访时ATRS达（92.7±3.6）分;Amer-Lindholm评分评价优15例、良6例,优良率为100％;单足提踵试验阳性率9.52%（2/21）,单足提踵恢复时间4~7 （5.1±0.9）个月。结论修复断端跟腱瘢痕组织治疗陈旧性跟腱断裂可以达到满意的临床疗效,且具有安全性高及并发症少等优点。

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关键词 ：腱损伤, 跟腱断裂, 瘢痕, 肌腱修复

Abstract：Objective To investigate the clinical effect of repairing the Achilles tendon cicatrix tissue for the treatment of chronic Achilles tendon ruptures. Methods A cross-sectional study was conducted on 21 patients with chronic Achilles tendon ruptures who had been treated operatively at the Department of Orthopedics, First Affiliated Hospital of the University of Science and Technology of China, from August 2018 to July 2021. Among the patients, 17 were males and 4 were females, aged 20-73 (43.5±16.0) years old. Eleven cases were on the right side, and 10 cases were on the left side. All cases were used to heal chronic Achilles tendon ruptures by repairing the Achilles tendon cicatrix tissue. The operation time, incision length, postoperative complications, and time of return to daily activities and sports were recorded. The American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were compared before and after the last follow-up. The Achilles tendon complete rupture score (ATRS), Arner-Lindholm score, and single-legged heel rise height test were recorded in the last follow-up. Results The operation time of patients was 30-50 minutes (average of 41.1 minutes), and the incision was 4-7 cm long (average of 5.6 cm). No serious complications, such as infection, sural nerve injury, or re-rupture, were observed after operation. All patients were followed up for 6-40 months (mean of 18.5 months). The average time of return to daily activities was (4.4±0.7) months, and the average time of return to sports was (11.1±1.5) months. The AOFAS ankle-hindfoot score increased from the preoperative (63.5±6.9) to (89.9±4.8) in the last follow-up with statistical significance(t=-14.45, P<0.001). VAS decreased from preoperative 4 (3,4) to 0(0,1)in the last follow-up with statistical significance (Z=5.69, P<0.001). The mean ATRS in the last follow-up was (92.7±3.6) points. The Arner-Lindholm score was excellent in 15 cases and good in 6 cases, and the good rate was 100%. The positive rate of the single-legged heel rise height test was 9.52%(2/21), and the average single-foot calf raise recovery time was 4-7 (5.1±0.9) months. Conclusion The application of repairing the Achilles tendon cicatrix tissue in the treatment of chronic Achilles tendon ruptures has satisfactory clinical efficacy and shows the advantages of safety and few complications.

Key words： Tendon injuries Achilles tendon ruptures Cicatrix Tendon repair

收稿日期: 2022-06-14

通讯作者: 俞光荣,Email：yuguangrong@hotmail.com

引用本文:

鹿亮, 李宁, 俞光荣. 跟腱断端瘢痕组织修复在陈旧性跟腱断裂治疗中的应用[J]. 中华解剖与临床杂志, 2022, 27(12): 831-835.
Lu Liang, Li Ning, Yu Guangrong. Application of scar tissue repair of the broken end of Achilles tendon in the treatment for old Achilles tendon ruptures. Chinese Journal of Anatomy and Clinics, 2022, 27(12): 831-835.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20220614-00185 或 http://www.cjac.com.cn/CN/Y2022/V27/I12/831

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