手术治疗新鲜跟腱断裂的体会

【摘要】 目的 探讨手术治疗新鲜跟腱断裂的临床疗效。方法 对66例跟腱断裂患者进行手术治疗，男34例，女32例，年龄24～59岁，平均(37.6±4.5)岁。本组术后早期进行功能锻练。术后测量双侧小腿最大周径及跟腱断裂平面的周径，询问恢复工作及伤前体育活动的时间。采用ArnerLindholm评分评价患者手术后功能恢复情况。结果 本组66例患者均获随访，随访时间16～36个月，平均(14.2±2.6)个月，无跟腱再断裂、切口表浅或深部感染、皮缘坏死等并发症。腓肠神经支配区皮肤感觉正常。43例恢复伤前工作与学习，恢复工作时间平均为10周(4～20周)。23例均恢复伤前体育活动，恢复伤前体育活动时间平均为20周(18～24周)。小腿最大周径伤侧较对侧平均减少0.4 cm(0.2～0.8 cm)，跟腱断裂平面周径伤侧较对侧平均增粗0.5 cm(0.3～0.7 cm)。按ArnerLindolm评分，优45例，良10例，可4例，差1例。结论 手术治疗跟腱断裂能够取得良好的临床效果。

【关键词】 跟腱断裂; 缝合技术; 重建

The clinical observation of repair of acute ruptures of achilles tendon YANG Jiang， XIE Jingyun， ZHONG Jiang， et al. Department of Orthopedics, The People Hospital of Leiyang，Leiyang 421800, China

【Abstract】 Objective To evaluate the clinical effect of repair acute achiles tendon ruptures. Methods Sixty six consecutive patients underwent repair acute achiles tendon ruptures between January 2000 and January 2010.There were 34 males and 32 females with an average age of (37.6±4.5)(ranged from 24~59) years in the series. All the cases benefited from a rehabilitation programme based on early range of motion exercise after surgery. These were evaluated the calf and ankle circumferences of the injured leg and the contralateral side, the return to work and sports activity time. The ArnerLindholm critera was used to evaluate the treatment outcomes. Results All the cases were followedup ranged from 16 to 36 months with an average of (14.2±2.6) months. No rerupture and nor deep or superficial wound infection happened in the series. No patient had sensory disturbance with the ankle or foot in the sural nerve distribution. Fortythree patients returned to work at an average of 10 weeks (ranged from 4 to 20 weeks) and to normal sports activities at 20 weeks (ranged from 18~24 weeks). Calf and ankle circumferences decreased by 0.4 cm(0.2~0.8 cm) and increased by 0.5 cm(0.3~0.7 cm),respectively in the injured leg as compared with the contralateral leg. According to ArnerLindholm critera, the outcomes were excellent in 45 cases, good in 10 cases, fair in 4 cases and poor in 1 case. Conclusion The combined repair acute achiles tendon ruptures and the early rehabilitation programme can achieve satisfactory result with low complication rates.

【Key words】 Achiles tendon rupture； Suture technique； Reconstruction

作者单位：421800 湖南省耒阳市人民医院骨二科 跟腱断裂是临床上比较常见的运动损伤。目前治疗跟腱断裂的手术方法有很多种［1,2］，笔者自2000年1月至2010年1月，采用手术治疗开放性跟腱断裂66例，获得较好疗效，报告如下。

1 资料与方法

1.1 一般资料 本组共66例，男34例，女32例，年龄24～59岁，平均(37.6±4.5)岁。右侧35例，左侧31例，均为新鲜断裂。伤后时间6 h内手术。开放锐器割伤18例，闭合性损伤48例。受伤程度：跟腱完全断裂24例，不完全断裂42例。根据Kuwade［3］分类法，Ⅰ型：19例，跟腱部分断裂，范围