CAJ | 학술논문

背景：急性跟腱断裂的临床治疗方案目前尚存争议，微创治疗因为切口相关并发症较少而逐渐被应用于临床，而微创手术与传统手术治疗急性跟腱断裂的比较性研究较少。 　　目的：比较应用跟腱龙（Achillon）跟腱吻合器与Krachow法跟腱端端吻合术治疗急性闭合性跟腱断裂的临床疗效。 　　方法：回顾性研究2009年3月至2011年12月收治的急性闭合性跟腱断裂患者146例，其中37例应用Achillon跟腱吻合器治疗，为微创手术组，男26例，女11例，年龄19~64岁，平均41.6岁；53例应用Krachow法跟腱端端吻合术治疗，为传统手术组，男36例，女17例，年龄21~67岁，平均43.5岁。比较两组患者的切口愈合时间、并发症发生率、踝关节活动度、单足提踵试验结果及整体满意率，并通过美国足踝外科协会（AOFAS）踝与后足评分进行疗效评估。 　　结果：微创手术组37例和传统手术组53例全部获得随访，随访时间为14~57个月，平均32.9个月。微创手术组的再断裂率与传统手术组比较无统计学差异（5.4%vs.1.9%， P=0.38）；传统手术组的伤口延迟愈合率显著高于微创手术组（17.6%vs.0%， P＜0.01）。两组患者的单足提踵试验阳性率（16.2%vs.11.3%）、踝关节活动度减小率（18.9%vs.17.0%）、整体满意率（83.8%vs.71.7%）均无统计学差异。两组患者的AOFAS踝与后足评分的各项指标和总分比较均无统计学差异。结论：Achillon跟腱吻合器治疗跟腱断裂可有效降低切口相关并发症发生率，且未增加跟腱再断裂率，跟腱功能与Kra-chow法跟腱端端吻合术无统计学差异。
배경：급성근건단렬적림상치료방안목전상존쟁의，미창치료인위절구상관병발증교소이축점피응용우림상，이미창수술여전통수술치료급성근건단렬적비교성연구교소。 　　목적：비교응용근건룡（Achillon）근건문합기여Krachow법근건단단문합술치료급성폐합성근건단렬적림상료효。 　　방법：회고성연구2009년3월지2011년12월수치적급성폐합성근건단렬환자146례，기중37례응용Achillon근건문합기치료，위미창수술조，남26례，녀11례，년령19~64세，평균41.6세；53례응용Krachow법근건단단문합술치료，위전통수술조，남36례，녀17례，년령21~67세，평균43.5세。비교량조환자적절구유합시간、병발증발생솔、과관절활동도、단족제종시험결과급정체만의솔，병통과미국족과외과협회（AOFAS）과여후족평분진행료효평고。 　　결과：미창수술조37례화전통수술조53례전부획득수방，수방시간위14~57개월，평균32.9개월。미창수술조적재단렬솔여전통수술조비교무통계학차이（5.4%vs.1.9%， P=0.38）；전통수술조적상구연지유합솔현저고우미창수술조（17.6%vs.0%， P＜0.01）。량조환자적단족제종시험양성솔（16.2%vs.11.3%）、과관절활동도감소솔（18.9%vs.17.0%）、정체만의솔（83.8%vs.71.7%）균무통계학차이。량조환자적AOFAS과여후족평분적각항지표화총분비교균무통계학차이。결론：Achillon근건문합기치료근건단렬가유효강저절구상관병발증발생솔，차미증가근건재단렬솔，근건공능여Kra-chow법근건단단문합술무통계학차이。
Background: For now, the treatment for the acute Achilles tendon rupture is remaining controversial. Minimally invasive techniques are reported with few incision related complications, thus are gradually being accepted in clinics. However, there are few comparative studies on the minimally invasive technique and the traditional operation in treating the acute Achilles tendon rupture. Objective: To compare the clinical outcomes of minimally invasive technique (Achillon) and traditional operation (Kra-chow) in treating the acute Achilles tendon rupture. Methods: To retrospectively study the 146 cases of acute Achilles tendon ruptures treated in our department from March 2009 to December 2011. Of the 146 cases, 37 cases (26 males and 11 females) with an average 41.6 (19-61) years old were treated with the Achillon, they were of the minimally invasive operation group; and 53 cases (36 males and 17 females) with an average of 43.5 (21-67) years old were treated with the Krachow, they were of the traditional operation group. The healing time of the incision, complication rate, range of motion of the ankle joint, single heel rise rate, and the overall satis-faction rate of the 2 groups were compared. And the curative effects were evaluated with the American Orthopaedic Foot&Ankle Society (AOFAS) ankle-hindfoot scale. Results: All the 37 cases and the 53 cases in the 2 groups were followed-up, the mean follow-up period was 32.9 (14-57) months. There was no statistical difference in the rerupture rate between the 2 groups (5.4%vs. 1.9%, P=0.38), while the inci-sion delayed union rate of the traditional operation group was significantly higher than the minimally invasive group (17.6%vs. 0%, P<0.01). The single heel rise positive rates (16.2%vs. 11.3%), reducing rates of the range of motion of the ankle joint (18.9%vs. 17.0%), and the overall satisfaction rates (83.8%vs. 71.7%) of the 2 groups have no statistical difference. The indi-cators and the total scores of the AOFAS ankle-hindfoot scale also reached no significant difference between the 2 groups. Conclusions: Minimally invasive technique can effectively reduce the incision related complication rate, and will not in-crease the rerupture rate of the Achilles tendon. The functional outcomes are similar between the minimally invasive tech-nique with the use of Achillon and the traditional treatment with the use of Krachow.