| 1.In vitro biomechanical analysis of double-anchored semi-Krackow locking "bridging" in the treatment of acute Achilles tendon ruptureObjective: To study the effect of different numbers of locking in Krackow suture on the stability of suture,and then to compare the biomechanical differences between the double-anchor semi-Krackow locking "bridging" method and the traditional Krackow suture,so as to verify the mechanical reliability of the double-anchor semi-Krackow locking "bridging" method in clinical practice.Methods: In experiment 1,18 bovine hoof tendons,all of which were 8cm in length,were randomly divided into three groups(A1,A2,A3),with 6 cases in each group.Their morphology was observed and their cross-sectional areas were recorded.The tendons were severed from the median to prepare an Achilles tendon rupture model.No.2 Ultrabraid sutures were used for Krackow suture in the three groups,and the number of locks were 3,4and 5 respectively.After suture,the tendons were placed on the electronic universal testing machine for mechanical analysis,and the instrument recorded 2mm crack tensile strength,fracture load and tensile strength,and then produced displacing load curve.Experiment 2:20 pieces of bovine hoof tendon with length of 10 cm were prepared and randomly divided into group B and group C,with 10 cases in each group.Their morphology was observed and their cross-sectional areas were recorded.The tendon was severed from the median to prepare an Achilles tendon rupture model.In group B,the broken tendon was repaired by double-anchored semi-Krackow locking "bridging" method.In group C,the ruptured tendon was repaired by Krackow suture.The repaired tendon was placed on an electronic universal testing machine for mechanical analysis.The instrument recorded 2mm crack tensile strength,maximum fracture load and tensile strength,and then produced displacing load curve.Finally,statistical analysis was conducted based on the above data.Results: In experiment 1,there were no significant differences in the tensile strength,fracture load and tensile strength of 2mm crack between A1,A2 and A3 groups(p≥0.05).In experiment 2,the mechanical indexes of 2mm crack tensile strength,fracture load and tensile strength of group B were all higher than those of group C(p< 0.01).Conclusions: 1.In Krackow suture method,when the number of locks on one end and one side is 3,there is no significant mechanical index difference between the suture with the number of locks of 4 and 5;2.The Krackow fracture method has a large fracture load,but its anti-fracture ability is weak.3.Compared with Krackow suture,the double-anchored semi-Krackow locking "bridging" method has stronger crack resistance,fracture load and tensile strength,which provides biomechanical basis for early and safe rehabilitation training of patients and reduces the incidence of early postoperative Achilles tendon re-fracture to a certain extent.2.Clinical application of double-anchored semi-Krackow locking "bridging" method in the treatment of acute Achilles tendon ruptureObjective: To compare the clinical efficacy of double-anchored semi-Krackow locking "bridging" method with traditional Krackow suture method in the repair of acute Achilles tendon rupture,and to discuss the therapeutic effect and clinical application value of double-anchored semi-Krackow locking "bridging" method.Methods: Retrospective study was conducted on patients with acute Achilles tendon rupture who met the inclusion criteria and were treated in the Second Affiliated Hospital of Inner Mongolia Medical University from January 2018 to December 2021.In the experimental group,the ankle joint was fixed in the functional position and underwent early functional rehabilitation training after operation by double-anchored semi-Krackow locking "bridge" method.The control group underwent traditional Krackow suture and traditional fixation and rehabilitation.The age of enrolled patients and the time from onset to operation were recorded.The main results of evaluation were AOFAS score and ATRS.Secondary outcomes were incision length,operation time,intraoperative incision closure tension,and complications such as incision cuticle necrosis and Achilles tendon re-rupture.Results: The sample size of the experimental group and the control group were 45 and 41 cases,respectively,and there was no significant difference in preoperative indexes between the two groups.AOFAS scores and ATRS scores of the experimental group were higher than those of the control group at 1,2,3 and 6 months after surgery,and the difference was statistically significant(p< 0.01).There was no significant difference between the AOFAS score and ATRS score at 9 and 12 months after surgery(p≥0.05).Incision length,operation time and incision closure tension of the experimental group were better than those of the control group(p< 0.01).There was no peripheral vascular nerve injury or recurrence of Achilles tendon rupture in 86 patients in both groups.All the surgical incisions in the experimental group achieved stage Ⅰ healing,and there was 1 case of anchor rejection.In the control group,3 cases of surgical incision cutaneous margin necrosis occurred.Conclusions: 1.The double-anchored semi-Krackow locking "bridging" method in the treatment of acute Achilles tendon rupture has the advantages of less trauma,short operation time and good early postoperative recovery effect;2.The Achilles tendon repaired by the double-anchored semi-Krackow locking "bridge" method is strong enough that the ankle joint can be fixed directly in the functional position after surgery,and early functional rehabilitation training can be carried out safely;3.The double anchor semi-Krackow locking "bridging" method combined with postoperative ankle functional position fixation and early postoperative functional rehabilitation training can make the Achilles tendon suffer from sustained stretch stress in the early stage,which is conducive to the repair of the injured Achilles tendon and reduce the occurrence of ankle stiffness and other problems,so as to improve the quality of life of patients in the early postoperative period and enable them to return to normal life and work more quickly. |
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