| Objective: Achilles tendon rupture incidence increased year by year,withthe strengthening of national fitness campaign.The treatment is still a lack ofconsensus although a number of research papers published, the hot disputesmainly about conservative and surgery, percutaneous and open surgicalprocedures, whether early rehabilitation.Treatment is divided into surgical andconservative treatment, surgical treatment including open sutures, minimallyinvasive sutures and percutaneous closed sutures, conservative treatmentincluding plaster braking and early rehabilitation exercises with abrace.Overseas research papers consider surgical treatment can reduce the rateof re-rupture, but increased wound complications;the percutaneous suture didnot increase the rate of re-rupture compared with traditional surgery, but itcan significantly reduce wound complications.At present,there are very fewprospective controlled studies on the efficacy of different surgical proceduresin domestic, so we designed a prospective controlled study that comparepercutaneous suture with traditional open suture treatment acute Achillestendon rupture, to provide the basis for the choice of treatment.Method: The patients who have the Achilles tendon rupture in our groupfrom2011.6to2013.9,will have a detailed explanation about percutaneoussuture and traditional open suture,then choose surgical method and sign theinformed consent by themselves.35patients were included in the study,16cases of percutaneous suture treatment (percutaneous group),19cases oftraditional open suture method of treatment(open group).Percutaneous group:15males,1female; aged18to57years, mean35.6years; open group:17males and2females; aged21to48years, mean36.2years.Postoperativerehabilitation exercises under the guidance of doctors,recording two operativetime, hospital stay, wound healing, sural nerve area feel the situation;Perform a single heel-rise test and record the results at3months;After6months offollow-up perform a single heel-rise test and record the results,whether limitedduring activities of daily living,with or without tendon adhesions, measuringthe maximum circumference of the calf,Achilles tendon rupture plane calfcircumference, and recorded the difference with contralateral,the rate ofre-rupture,Use ATRS (Achilles tendon Total Rupture Score)functionalassessment,Telephone follow-up to understand whether the re-ruptureannually.SPSS13.0statistical software for statistical analysis.Result: All patients were followed up: open group was6to24months(mean10months), percutaneous group was6to23months (mean10.5months);all patients were returned to the original work.Wound healing:opengroup have3cases with incision superficial infection, skin necrosis, no deepinfections,healed by debridement and changing dressing;1patients of opengroup who application Ethibond nonabsorbable suture occurs suturerejection,due to incision sustained sinus formation,the incision gained healingby surgical debridement again at3months postoperative;Percutaneous groupwas no wound complications.The results of a single heel-rise test at3months:Open group8patients,the positive rate was42.1%; percutaneousgroup6patients, the positive rate was37.5%.The results of follow-up after6months:ATRS,open group was86±7, percutaneous group was88.5±5;all patients were negative about a single heel-rise test at last follow-up;suralnerve injury: open group0cases, Percutaneous group1cases and who suralnerve paresthesia recovery after3months; Achilles tendon adhesions: opengroup2cases, percutaneous group0cases;open group two cases ofre-rupture,1case Without permission to load walking1monthspostoperative,1case fall accidentally and re-rupture when the functionalexercise,1months postoperative,2cases gained cure by the original incisionsutured end to end and the plantar tendon reinforcement, ATRS were70and78after6months reoperation,were lower than the average score of86opengroup;The total complication rate: open group have8cases (42.1%),Percutaneous group have1case (6.3%). Follow-up time,the difference of contralateral and ipsilateral calfmaximum circumference, ATRS score, positive rate a single heel-rise test at3months, incidence of complications incision,incidence of re-rupture,incidenceof tendon adhesions, sural nerve injury rate There was no significantdifference between the two groups;Ipsilateral calf maximum circumferencecompared with the contralateral, ipsilateral Achilles tendon rupture plane calfcircumference compared with the contralateral, the difference was statisticallysignificant;Hospitalization, surgery time, the difference of contralateral andipsilateral Achilles tendon rupture plane calf circumference,total complicationrate, There was significant difference between the two groups.The groupsaccording to positive result a single heel-rise test at3months,analysisdifferences of ages and ATRS,found that the differences of ages andATRS have statistically significant.Conclusions：1You can get the same functional results compare percutaneous suturewith traditional open suture treatment acute Achilles tendon rupture, and cansignificantly shorten the hospital stay, operative time;percutaneous suture didnot increase the rate of re-rupture,but it can reduce the incidence ofcomplications incision;percutaneous suture closure can occur sural nervedamage, but the difference between the two surgical methods have nostatistics significance;percutaneous suture closure can significantly reducetotal complication than traditional surgery.2Ipsilateral calf maximum circumference narrowed compared with thecontralateral,but the difference of narrowing between the two groups was notstatistically significant;ipsilateral Achilles tendon rupture plane calfcircumference increases compared with the contralateral,and the difference ofincreasing between the two groups have statistically significant,Percutaneousgroup increases more.3Re-rupture patients, ATRS score lower, Re-rupture is a seriouscomplication imaging capabilities of the results.4Early a single heel-rise test negative patients, the age lower, the ATRS score higher. |
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