跟腱断裂修复存在的问题及解决新策略PPT课件

跟腱急性断裂常见于运动损伤和锐器割伤。划佣受伤位置您健中国花样滑冰名将赵宏博NBA球星科比·布莱恩特非手术治疗：石膏或支具再断裂率跟腱断裂的感染、切口裂开、皮肤粘连治疗切开手术缝合手术治疗：经皮微创缝合创伤小、固定效果好，但存在腓肠神经损伤、手术时间长、副损伤大等原因，限制其推广和应用。切开缝合跟腱。伤口愈合问题6-23%·深部感染2-13%。腓肠神经损伤1-20%再断裂率。0.6-6%(2%)Nistor 1981,Beskin et al.1987,Zwipp et al.1989,Wills et al.1996,Lo et al.1997,Winter et al.1998,Bruggemann et al.2004,Pajala etal.2002,20092202COPYRIGHT O 2005 BY THE JOURNAL OF BONE AND JOINT SURGERY.INCORPORATEDTREATMENT OF ACUTEACHILLES TENDON RUPTURESA META-ANALYSIS OF RANDOMIZED,CONTROLLED TRIALSBY RIAZ J.K.KHAN,FRCS(TR&ORTH),DAN FICK,MBBS,ANGUS KEOGH,MBBS,JOHN CRAWFORD,FRCS(TR&ORTH),TIM BRAMMAR,FRCS(TR&ORTH),AND MARTYN PARKER,MDInvestigation performed at Perth Orthopaedic Institute.Department of Surgery and Pathology.University of Western Australia,Perth.Australiatunctional brace.Ine aim ot this meta-analysis was to identiry and summarize tne evidence trom rangomized,con-trolled trials on the effectiveness of different interventions for the treatment of acute Achilles tendon ruptures.Methods:We searched multiple databases (including EMBASE,CINAHL,and MEDLINE)as well as reference lists ofarticles and contacted authors.Keywords included Achilles tendon,rupture,and tendon injuries.Three reviewers ex-Khan RJ,Fick D,Keogh A,tracted data and independently assessed trial quality with use of a ten-item scale.et al.Treatment of acuteResults:Twelve trials involving 800 patients were included.There was a variable level of methodological rigor and re-porting of outcomes.Open operative treatment was associated with a lower risk of rerupture compared with nonoper-achilles tendon ruptures.ative treatment(relative risk,0.27:95%confidence interval,0.11 to 0.64).However,it was associated with a higherrisk of other complications,including infection,adhesions,and disturbed skin sensibility (relative risk,10.60;95%The journal of bone &jointconfidence interval,4.82 to 23.28).Percutaneous repair was associated with a lower complication rate comparedsurgery.2005,8710):2202-with open operative repair(relative risk,2.84;95%confidence interval,1.06 to 7.62).Patients who had been man-aged with a functional brace postoperatively(allowing for early mobilization)had a lower complication rate compared2211.with those who had been managed with a cast(relative risk,1.88;95%confidence interval,1.27 to 2.76).Becauseof the small number of patients involved,no definitive conclusions could be made regarding different nonoperativetreatment regimens经皮微创缝合能够收到切开修复缝合跟腱同样的效果，再断裂率低、伤口问题少，有明显的优势