急性アキレス腱断裂の低侵襲修復のための術中超音波検査の補助

Intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.

• Yang Yongliang
• Jia Honglei
• Zhang Wupeng
• Xu Shihong
• Wang Fu
• Wang Bomin
• Li Qinghu
• Wang Yonghui
• Han Shumei

抄録

背景:

アキレス腱断裂に対しては、保存的治療や従来の開腹手術よりも再破裂や創部関連の合併症が少なく、低侵襲的な修復術の方が良い選択肢である。主な問題は硬膜神経損傷である。本研究の目的は、急性アキレス腱断裂に対する低侵襲修復の術中超音波検査補助の効果と利点を評価することであった。

BACKGROUND: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.

方法:

2015年1月から2017年12月までに術中超音波検査を補助した低侵襲修復術で治療した急性アキレス腱断裂36例を対象にレトロスペクティブ研究を行った。術前MRIで硬膜神経と小伏在静脈の関係を確認した。術中超音波検査で小伏在静脈と硬膜神経の経過を確認し、マーキングを行った。破断したアキレス腱は小伏在静脈（SSV）の内側に低侵襲のブンネル縫合で修復された。

METHODS: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and the sural nerve was identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein (SSV).

結果:

RESULTS: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78 ± 1.40 weeks and 17.28 ± 2.34 weeks, respectively. The Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 59.17 ± 5.31 preoperatively to 98.92 ± 1.63 at the time of 12 months follow-up. There was a statistically significant difference (P < 0.001). No patient complained of a negative effect on their life.

結論:

術中超音波検査を用いた低侵襲修復は、良好な臨床結果、手術時間の短縮、合併症の軽減、特に硬膜神経損傷の軽減が期待できます。これは急性アキレス腱（AT）断裂に対する効率的で信頼性が高く、安全な方法である。

CONCLUSIONS: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time, and less complications, especially sural nerve injury. It is an efficient, reliable, and safe method for acute Achilles tendon (AT) rupture.