CAJ | 학술논문

目的比较小切口与常规切口端端缝合治疗新鲜跟腱断裂的疗效.方法 2006年3月至2009年6月分别采用常规切口和小切口治疗93例新鲜跟腱断裂患者,其中常规切口组(A组)52例,男47例,女5例；年龄23～62岁,平均44.2岁.小切口组(B组)41例,男38例,女3例；年龄22～65岁,平均42.6岁.术后应用相同的康复程序,采用临床客观检查、患者主观满意率及美国足踝外科协会(AOFAS)评分进行评价.结果 A组患者术后获15 ～52个月(平均28个月)随访,B组患者术后获13～50个月(平均26个月)随访.A组切口表浅感染6例,深部感染l例,感染率为13.5％,B组均未发生切口感染等并发症；A组平均切口长度较B组长7.3 cm；A组平均AOFAS评分为93分,B组为98分,以上指标两组比较差异均有统计学意义(P＜0.05).跟腱与皮肤切口粘连发生率、再断裂率、踝关节活动受限发生率、患者满意率、小腿最大周径伤侧与对侧的差、跟腱断裂平面周径伤侧与对侧的差及恢复伤前活动时间两组比较差异均无统计学意义(P＞0.05).两组患者均未产生因腓肠神经损伤导致的足背皮肤感觉障碍,无小腿深静脉血栓形成.除l例发生深部感染,其他患者均恢复伤前活动.结论应用跟腱缝合引导器及小切口微创修复新鲜腱断裂总体结果优于常规切口技术.
목적 비교소절구여상규절구단단봉합치료신선근건단렬적료효.방법 2006년3월지2009년6월분별채용상규절구화소절구치료93례신선근건단렬환자,기중상규절구조(A조)52례,남47례,녀5례；년령23～62세,평균44.2세.소절구조(B조)41례,남38례,녀3례；년령22～65세,평균42.6세.술후응용상동적강복정서,채용림상객관검사、환자주관만의솔급미국족과외과협회(AOFAS)평분진행평개.결과 A조환자술후획15 ～52개월(평균28개월)수방,B조환자술후획13～50개월(평균26개월)수방.A조절구표천감염6례,심부감염l례,감염솔위13.5％,B조균미발생절구감염등병발증；A조평균절구장도교B조장7.3 cm；A조평균AOFAS평분위93분,B조위98분,이상지표량조비교차이균유통계학의의(P＜0.05).근건여피부절구점련발생솔、재단렬솔、과관절활동수한발생솔、환자만의솔、소퇴최대주경상측여대측적차、근건단렬평면주경상측여대측적차급회복상전활동시간량조비교차이균무통계학의의(P＞0.05).량조환자균미산생인비장신경손상도치적족배피부감각장애,무소퇴심정맥혈전형성.제l례발생심부감염,기타환자균회복상전활동.결론 응용근건봉합인도기급소절구미창수복신선건단렬총체결과우우상규절구기술.
Objective To compare clinical and functional outcomes between conventional and minimally invasive treatment of acute rupture of the Achilles tendon.Methods From March 2006 to June 2009,93 patients with fresh rupture of the Achilles tendon received either conventional or minimally invasive treatment in our hospital.Fifty-two patients,47 men and 5 women,aged from 23 to 62 years (average,44.2years),had a Bunnell end-to-end suture repair (group A),while 41 patients,38 men and 3 women,aged from 22 to 65 years (average,42.6 years),had a minimally invasive repair (group B).The same functional rehabilitation protocol was adopted after surgery for both groups.Clinical and functional outcomes were evaluated and compared according to clinical check-ups,The American Orthopaedic Foot & Ankle Society (AOFAS) score and rate of subjective satisfaction of the patient.Results The average follow-up period was 28 months (range,15 to 52 months) for group A and 26 months (range,13 to 50 months) for group B.Deep or superficial wound infection occurred in 7 cases (13.5％) in group A,but none in group B ( P =0.043).The mean incision was 7.3 cm longer in group A as compared with group B ( P =0.000).The mean AOFAS score was 93 points in group A as compared with 98 points in group B( P =O.026).Differences between the 2 groups with regard to incidence of rerupture,limited joint activity,adhesion and rate of satisfaction were not significant ( P ＞ 0.05).No significant differences were found between the 2 groups with regard to calf and ankle circumferences and time for returned to normal sports (P ＞ 0.05).No patient had sensory disturbance in the sural nerve distribution.All patients return to normal sports except one case who had a deep wound infection.Conclusion Minimally invasive treatment have advantages over conventional treatment for fresh ruptures of the Achilles tendon.