CAJ | 학술논문

目的回顾性比较筋膜反转法与直接吻合法修复急性跟腱断裂的优缺点.方法 2001年1月至2005年10月收治且获得随访73例急性跟腱断裂患者,采用筋膜反转法治疗,为筋膜反转组,男54例,女19例;平均(47.6±11.2)岁;受伤至手术时间平均为(6.2±4.2)d.2005年11月至2009年5月收治且获得随访82例急性跟腱断裂患者,采用直接吻合法治疗,为直接吻合组,男65例,女17例;平均(43.7±8.4)岁;受伤至手术时间平均为(7.1±5.3)d.记录两组患者的术后伤口愈合时间、踝关节活动度、单足提踵试验结果及患者的满意度,并采用美国足踝外科协会(AOFAS)踝与后足评分系统评价术后疗效. 结果 155例患者术后获13～114个月(平均63.5个月)随访.筋膜反转组和直接吻合组的跟腱二次断裂率分别为4.1%(3/73)、2.4%(2/82),单足提踵试验阳性率分别为13.7%(10/73)、8.5%(7/82),背伸小于对侧足50%的阳性率分别为23.3%(17/73)、18.3%(15/82),跖屈小于对侧50%的阳性率分别为12.3%(9/73)和6.1%(5/82),满意率分别为82.2%(60/73)、80.5%(66/82),AOFAS踝与后足评分平均分别为(97.2±9.4)分和(94.3±12.1)分,以上指标两组比较差异均无统计学意义(P＞0.05).两组患者伤口延迟愈合率分别为15.1%(11/73)、3.7%(3/82),差异有统计学意义(t=6.119,P=0.013).结论筋膜反转加强跟腱修补并不能减少跟腱的再次断裂,却有可能导致伤口的延迟愈合.
목적 회고성비교근막반전법여직접문합법수복급성근건단렬적우결점.방법 2001년1월지2005년10월수치차획득수방73례급성근건단렬환자,채용근막반전법치료,위근막반전조,남54례,녀19례;평균(47.6±11.2)세;수상지수술시간평균위(6.2±4.2)d.2005년11월지2009년5월수치차획득수방82례급성근건단렬환자,채용직접문합법치료,위직접문합조,남65례,녀17례;평균(43.7±8.4)세;수상지수술시간평균위(7.1±5.3)d.기록량조환자적술후상구유합시간、과관절활동도、단족제종시험결과급환자적만의도,병채용미국족과외과협회(AOFAS)과여후족평분계통평개술후료효. 결과 155례환자술후획13～114개월(평균63.5개월)수방.근막반전조화직접문합조적근건이차단렬솔분별위4.1%(3/73)、2.4%(2/82),단족제종시험양성솔분별위13.7%(10/73)、8.5%(7/82),배신소우대측족50%적양성솔분별위23.3%(17/73)、18.3%(15/82),척굴소우대측50%적양성솔분별위12.3%(9/73)화6.1%(5/82),만의솔분별위82.2%(60/73)、80.5%(66/82),AOFAS과여후족평분평균분별위(97.2±9.4)분화(94.3±12.1)분,이상지표량조비교차이균무통계학의의(P＞0.05).량조환자상구연지유합솔분별위15.1%(11/73)、3.7%(3/82),차이유통계학의의(t=6.119,P=0.013).결론 근막반전가강근건수보병불능감소근건적재차단렬,각유가능도치상구적연지유합.
Objective To retrospectively compare the advantages and disadvantages of reverse flap of gastrocnemius-soleus fascia and direct anastomosis for the repair of acute Achilles tendon rupture.Methods From January 2001 to October 2005, 73 cases of acute Achilles tendon rupture were treated with reverse flap of gastrocnemius-soleus fascia. They were 54 males and 19 females. Their average age was (47.6 ± 11.2) years old. From November 2005 to May 2009, 82 cases were treated with direct anastomosis.They were 65 males and 17 females. Their average age was (43.7 ± 8.4) years old. The time from injury to surgery was (6.2 ±4.2) days and (7.1 ±5.3) days respectively for the 2 groups, with no statistic differences. The patients were evaluated by the Ankle and Hindfoot score system American Orthopaedic Foot and Ankle Society(AOFAS) . The result was considered as positive when the range of dorsal or plantar flexion of the operated side was 50% smaller than the opposite, or when the single heel rise was less than 10 times.Results The follow-ups lasted 13 to 114 months (average, 63.5 months). The rates of re-rupture in the 2 groups were respectively 4. 1% and 2.4%. Disability in single heel rise was respectively 13.7% and 8.5%,in normal dorsal extension respectively 23.3% and 18.3%, and in normal plantar flexion respectively 12.3%and 6.1%. The satisfaction rates were respectively 82. 2% and 80. 5%. AOFAS scores were respectively 97.2 ± 9.4 and 94. 3 ± 12. 1. All the differences above were not statistically significant ( P ＞ 0.05) . The delayed wound healing in the 2 groups were respectively 15.1% and 3.7%, with statistically significant differences ( t = 6. 119, P = 0. 013) . Conclusion The reverse fascia flap for repair of acute Achilles tendon rupture may not decrease the re-rupture rate but may increase the possibility of wound healing delay.