截骨与止点重建治疗顽固性止点跟腱炎的比较
Zadek osteotomy versus Achilles tendon insertion reconstruction for intractable insertional Achilles tendinitis
李帅 1杨鑫权 2张言 2赵宏谋 2梁晓军2
作者信息
- 1. 西安医学院,陕西西安 710068
- 2. 西安交通大学附属红会医院足踝外科,陕西西安 710054
- 折叠
摘要
[目的]比较Zadek截骨术与跟腱止点重建术治疗顽固性止点性跟腱炎的临床疗效.[方法]回顾性分析2019年8月-2023年4月,在本中心手术治疗的44例(47足)止点性跟腱炎患者的临床资料.根据医患沟通结果,截骨组18例(20足),重建组26例(27足).比较两组患者围手术期、随访及影像结果.[结果]两组患者均顺利完成手术,截骨组手术时间[(50.8±11.7)min vs(65.4±25.0)min,P＜0.001]、切口总长度[(4.7±0.7)cm vs(6.8±0.7)cm,P＜0.001]、下地行走时间[(25.3±3.5)d vs(36.6±6.9)d,P＜0.001]、住院天数[(4.9±0.8)d vs(7.0±2.5)d,P＜0.001]均显著少于重建组.随访时间平均(26.2±11.8)个月.截骨组恢复完全负重活动时间[(10.9±1.0)d vs(15.3±0.9)d,P＜0.001]显著早于重建组.术后两组VAS评分显著减少(P＜0.05),AOFAS评分、VISA-A评分、Tegner评分、SF-12 MCS评分、SF-12PCS评分均显著增加(P＜0.05),末次随访,两组上述指标的差异均无统计学意义(P＞0.05).影像方面,与术前相比,末次随访时,两组骨赘、止点骨水肿、腱膜增厚、Fowler-Philip角均显著改善(P＜0.05),末次随访时,重建组骨赘变化、腱膜增厚及FPA角均显著优于截骨组(P＜0.05),但是,两组止点骨水肿的差异无统计学意义(P＞0.05).[结论]两组患者术后在疼痛、功能及整体生活质量方面均获得明显改善,临床疗效无显著差异.但Za-dek截骨术具有创伤小、手术时间短及并发症少等优势.
Abstract
[Objective]To compare the clinical outcomes of Zadek osteotomy versusresection of the calcaneal prominence and Achilles tendon insertion reconstruction for intractable insertional Achilles tendinitis(IAT).[Methods]A retrospective study was done on 44 patients(47 feet)who underwent surgical treatment for intractable IAT in our department from August 2019 to April 2023.According to preoperative doctor-patient communication,18 patients(20 feet)received Zadek osteotomy(the osteotomy group),while other 26 patients(27 feet)under-went resection of the calcaneal prominence and Achilles tendon insertion reconstruction(the reconstruction group).The perioperative period,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups had operation conducted success-fully.The osteotomy group was significantly superior to the reconstruction group in terms of the operation time[(50.8±11.7)min vs(65.4±25.0)min,P＜0.001],the total incision length[(4.7±0.7)cm vs(6.8±0.7)cm,P＜0.001],ambulation time[(25.3±3.5)days vs(36.6±6.9)days,P＜0.001],hospitalization days[(4.9±0.8)days vs(7.0±2.5)days,P＜0.001].The average follow-up time was of(26.2±11.8)months,and the osteotomy group regained full weight-bearing activity significantly earlier than the reconstruction group[(10.9±1.0)days vs(15.3±0.9)days,P＜0.001].The VAS score for pain significantly decreased(P＜0.05),while AOFAS score,VISA-A score,Tegner score,SF-12 MCS score and SF-12 PCS score significantly increased in both groups after surgery(P＜0.05).At the last follow-up,there were no statistically signifi-cant differences in the above indexes between the two groups(P＞0.05).As for imaging,osteophyte,insertional bone edema,aponeurosis thickening and Fowler-Philip angle(FPA)were significantly improved in both groups at the last follow-up compared with those preoperative-ly(P＜0.05).At the last follow-up,the osteotomy group was inferior to the reconstruction group regarding to osteophyte changes,aponeurosis thickening and FPA(P＜0.05),but there was no significant difference in bone edema between the two groups(P＞0.05).[Conclusion]Both procedures achieve similar clinical consequence in terms of pain relief,and improvement of function and overall quality of life.By compari-son,the Zadek osteotomy has the advantages of less trauma,shorter operation time and fewer complications over the tendon insertion recon-struction.
关键词
止点性跟腱炎/止点重建术/Zadek截骨术/手术治疗Key words
insertional Achilles tendinitis/Achilles tendon insertion reconstruction/Zadek osteotomy/surgical treatment引用本文复制引用
出版年
2024
NETL
NSTL
万方数据