全关节镜下自体肌腱悬吊固定治疗老年非止点性MyersonⅢ型陈旧性跟腱断裂

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目的:探讨全关节镜下自体肌腱悬吊固定治疗老年非止点性MyersonⅢ型陈旧性跟腱断裂的临床疗效。方法:回顾性分析2016年2月至2019年2月采用全关节镜下自体肌腱悬吊固定治疗18例老年非止点性MyersonⅢ型陈旧性跟腱断裂患者资料,男12例,女6例;年龄60~79岁,平均65.3岁;右侧10例,左侧8例;受伤至手术时间6~32周,平均12周。术后采用视觉模拟评分(visual analogue scale,VAS)、美国足踝外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝-后足评分、跟腱完全断裂评分(achilles tendon total rupture score, ATRS)评价足踝部功能恢复情况,按照Arner-Lindholm评分评定跟腱功能。结果:术后18例患者均获得随访,随访时间12~50个月,平均18.6个月;无一例发生切口感染、腓肠神经损伤、跟腱再次断裂等并发症。末次随访时,跟腱连续性均得到重建,VAS、AOFAS踝-后足及ATRS评分分别为0分(0,1)、(92.6±4.3)分(范围86~100)分、(93.1±3.2)分(范围88~100分),与术前[4分(1,7)、(60.3±9.7)分(范围40~83分)、(55.7±10.6)分(范围42~80分)]比较,差异均有统计学意义(n Z=2.334、n t=34.541、n t=64.773,均n P< 0.05)。根据Arner-Lindholm评分,优14例,良4例,优良率为100%(18/18)。末次随访时,1例患者不能完成单足提踵运动,因可忍受,未进一步治疗;1例诉长时间运动后有跟部轻微疼痛感,经持续拉伸跟腱锻炼后得到缓解。n 结论:全关节镜下自体肌腱悬吊固定治疗老年非止点性MyersonⅢ型陈旧性跟腱断裂,近期临床效果满意,具有创伤小、恢复快、并发症少等优点。“,”Objective:To evaluate the clinical outcome of all arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients.Methods:Data of 18 patients with Myerson type III chronic noninsertional Achilles tendon rupture who had performed all arthroscopic autogenous tendon suspended fixation from February 2016 to February 2019 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital were retrospectively analyzed. There were 12 males and 6 females (right side, 10 cases and left side, 8 cases) aged from 60 to 79 years with a median of 65.3 years. The mean injury-to-surgery time was 12 weeks (range, 6-32 weeks). All the patients were treated by all arthroscopic autogenous tendon suspended fixation. The function of the ankle and the foot was assessed using visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) foot and ankle score and the achilles tendon total rupture score (ATRS), and the excellent and good rate was evaluated according to Arner-Lindholm score.Results:All patients healed at the first stage without any complications such as infection, sural nerve injury or tend re-rupture. The mean follow-up period was 18.6 months (range, 12-50 months). At the latest follow-up, all achilles tendons were healed with the VAS score reduced from 4 (1, 7) preoperatively to 0 (0, 1) postoperatively (n Z=2.334, n P< 0.05); the AOFAS ankle and hindfoot score was improved from 60.3±9.7 (range, 40-83) preoperatively to 92.6±4.3 (range, 86-100) postoperatively (n t=34.541, n P< 0.05); the ATRS score was improved from 55.7±10.6 (range, 42-80) preoperatively to 93.1±3.2 (range, 88-100) postoperatively (n t=64.773, n P< 0.05); one patient was unable to stand on tiptoe of the single injured limb, because he could stand it, no further treatment was given; another patient complained of mild pain after a long time walking,which was alleviated by stretching the achilles tendon consistently. According to the score of Arner-Lindholm, 14 cases were excellent, 4 cases were good, and the excellent and good rate was 100% (18/18).n Conclusion:All arthroscopic autogenous tendon suspended fixation for Myerson type III chronic noninsertional achilles tendon rupture in elderly patients is an effective method, which has the advantages of less trauma, faster recovery and fewer complications.
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