PDF(Pubmed)
Abstract：
BACKGROUND: The Achilles tendon is the strongest tendon in the human body and has the function of plantar ankle flexion. When the tendon is exposed, the peritendineum has been breached and the thick avascular tendon colonized with bacteria, a complete resection of the tendon may be indicated to achieve infection control and facilitate wound closure. The Achilles tendon reconstruction is not mandatory, as the plantar flexion of the ankle joint is assumed by the remaining flexor hallucis longus, flexor digitorum longus and tibialis posterior muscles. Our study aimed to evaluate the impact of Achilles tendon resection without reconstruction on leg function and quality of life.
METHODS: We retrospectively evaluated all patients who were treated with an Achilles tendon resection between January 2017 and June 2022 in our quaternary institution. After evaluating the data, the patients who survived and were not amputated were contacted for re-evaluation, which included isokinetic strength measurement of both ankle joints, evaluation of the ankle range of motion and collection of several functional scores.
RESULTS: Thirty patients were included in the retrospective study, with a mean age of 70.3 years, including 11 women and 19 men. The most frequent cause of the infection was leg ulcer (43.3%), followed by open tendon suture (23.3%). No tendon reconstruction was performed. Fifteen patients could be gained for reevaluation. The average difference in ankle flexion torque on the injured side compared to the healthy side at 30 degrees/second was 57.49% (p = 0.003) and at 120 degrees/second was 53.13% (p = 0.050) while the difference in power was 45.77% (p = 0.025) at 30 degrees/second and 38.08% (p = 0.423) at 120 degrees/second. The follow-up time was between 4 and 49 months and a positive correlation could be determined between the time elapsed from surgery and the ankle joint strength. There was a significant loss of range of motion on the operated side compared to the healthy side: 37.30% for plantar flexion, 24.56% for dorsal extension, 27.79% for pronation and 24.99% for supination. The average Lepillhati Score was 68.33, while the average American Orthopedic Foot and Ankle Score was 74.53.
CONCLUSIONS: The complete Achilles tendon resection leaves the patient with satisfactory leg function and an almost normal gait. Especially in elderly, multimorbid patients, straightforward tendon resection and wound closure provide fast infection control with acceptable long-term results. Further prospective studies should compare the ankle function and gait in patients with and without Achilles tendon reconstruction after complete resection.
METHODS: We retrospectively evaluated all patients who were treated with an Achilles tendon resection between January 2017 and June 2022 in our quaternary institution. After evaluating the data, the patients who survived and were not amputated were contacted for re-evaluation, which included isokinetic strength measurement of both ankle joints, evaluation of the ankle range of motion and collection of several functional scores.
RESULTS: Thirty patients were included in the retrospective study, with a mean age of 70.3 years, including 11 women and 19 men. The most frequent cause of the infection was leg ulcer (43.3%), followed by open tendon suture (23.3%). No tendon reconstruction was performed. Fifteen patients could be gained for reevaluation. The average difference in ankle flexion torque on the injured side compared to the healthy side at 30 degrees/second was 57.49% (p = 0.003) and at 120 degrees/second was 53.13% (p = 0.050) while the difference in power was 45.77% (p = 0.025) at 30 degrees/second and 38.08% (p = 0.423) at 120 degrees/second. The follow-up time was between 4 and 49 months and a positive correlation could be determined between the time elapsed from surgery and the ankle joint strength. There was a significant loss of range of motion on the operated side compared to the healthy side: 37.30% for plantar flexion, 24.56% for dorsal extension, 27.79% for pronation and 24.99% for supination. The average Lepillhati Score was 68.33, while the average American Orthopedic Foot and Ankle Score was 74.53.
CONCLUSIONS: The complete Achilles tendon resection leaves the patient with satisfactory leg function and an almost normal gait. Especially in elderly, multimorbid patients, straightforward tendon resection and wound closure provide fast infection control with acceptable long-term results. Further prospective studies should compare the ankle function and gait in patients with and without Achilles tendon reconstruction after complete resection.
摘要：
背景：跟腱是人体中最强的肌腱，具有足踝屈曲功能。当肌腱露出时，室管膜周围已经被破坏，厚厚的无血管肌腱被细菌定植，可能需要完全切除肌腱以实现感染控制并促进伤口闭合。跟腱重建不是强制性的,由于踝关节的足底屈曲由剩余的长屈肌承担，指长屈肌和胫骨后肌。我们的研究旨在评估无重建跟腱切除术对腿部功能和生活质量的影响。
方法：我们回顾性评估了2017年1月至2022年6月在我们的四元机构接受跟腱切除术治疗的所有患者。在评估数据之后,存活且未截肢的患者被联系以进行重新评估，其中包括两个踝关节的等速强度测量，评估踝关节的活动范围并收集几种功能评分。
结果：30例患者被纳入回顾性研究，平均年龄为70.3岁,包括11名女性和19名男性。感染最常见的原因是腿部溃疡(43.3%),其次是开放肌腱缝合（23.3％）。没有进行肌腱重建。可以获得15名患者进行重新评估。在30度/秒时，受伤侧的踝关节屈曲扭矩与健康侧的平均差异为57.49％（p=0.003），在120度/秒时为53.13％（p=0.050），而功率差异在30度/秒时为45.77％（p=0.025），在120度/秒时为38.08％（p=0.423）。随访时间为4至49个月，可以确定手术时间与踝关节强度之间存在正相关。与健康侧相比，手术侧的运动范围明显下降：足底屈曲为37.30％，背部伸展24.56%，内旋27.79%，旋旋24.99%。平均Lepillhati评分为68.33，而美国骨科足踝平均评分为74.53。
结论：完整的跟腱切除使患者的腿部功能令人满意，步态几乎正常。尤其是老年人,多发性病人，简单的肌腱切除和伤口闭合可提供快速的感染控制和可接受的长期结果。进一步的前瞻性研究应比较完整切除后有和没有跟腱重建的患者的踝关节功能和步态。
方法：我们回顾性评估了2017年1月至2022年6月在我们的四元机构接受跟腱切除术治疗的所有患者。在评估数据之后,存活且未截肢的患者被联系以进行重新评估，其中包括两个踝关节的等速强度测量，评估踝关节的活动范围并收集几种功能评分。
结果：30例患者被纳入回顾性研究，平均年龄为70.3岁,包括11名女性和19名男性。感染最常见的原因是腿部溃疡(43.3%),其次是开放肌腱缝合（23.3％）。没有进行肌腱重建。可以获得15名患者进行重新评估。在30度/秒时，受伤侧的踝关节屈曲扭矩与健康侧的平均差异为57.49％（p=0.003），在120度/秒时为53.13％（p=0.050），而功率差异在30度/秒时为45.77％（p=0.025），在120度/秒时为38.08％（p=0.423）。随访时间为4至49个月，可以确定手术时间与踝关节强度之间存在正相关。与健康侧相比，手术侧的运动范围明显下降：足底屈曲为37.30％，背部伸展24.56%，内旋27.79%，旋旋24.99%。平均Lepillhati评分为68.33，而美国骨科足踝平均评分为74.53。
结论：完整的跟腱切除使患者的腿部功能令人满意，步态几乎正常。尤其是老年人,多发性病人，简单的肌腱切除和伤口闭合可提供快速的感染控制和可接受的长期结果。进一步的前瞻性研究应比较完整切除后有和没有跟腱重建的患者的踝关节功能和步态。
