孟加拉国玛丽玛丽亚医院急诊科开放性腱鞘跟腱损伤初次修复术效果评估。

Mymensingh medical journal : MMJ Pub Date : 2024-10-01
K H Rahman, M S Islam, D C Burman, M A Hoque, M I H Shakil, A Ullah, M A Ali, M K Roy, M T Alam
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引用次数: 0

摘要

近年来,由于各种原因造成的跟腱损伤日益增多。跟腱损伤是一种致残性疾病,如果断裂肌腱的两端之间存在间隙或缺损,则很难治疗。跟腱断裂的患者应立即进行手术。我国大多数人在厕所里使用与厕所地面同高的扁平便盆。厕板表面破损会造成锋利的割伤。一些开放性肌腱损伤的病例是由于道路交通事故、被碎玻璃划伤以及攻击造成的。人们普遍认为,跟腱新鲜断裂的手术修复效果极佳。本研究的目的是评估开放性跟腱损伤(OTAI)初次修复的效果。这项前瞻性研究于 2021 年 10 月至 2022 年 6 月期间在孟加拉国迈门辛医学院医院伤科进行。研究随机选取了在急诊科就诊的 OTAI 患者。所有病例均被选为在 12 小时内未伴有其他腿部肌肉、胫后动脉和神经损伤的 OTAI。所有患者都接受了改良凯斯勒法的端对端初级修复术。对 OTAI 初级修复术的结果进行了评估,找出了常见的损伤原因、年龄和性别发生率、损伤程度,并提出了一套方案,以舒适、廉价和方便的方式为患者治疗此类病例。手术在伤员手术室(COT)进行。随后,48 名患者在伤科接受了随访。其中,43(89.58%)名患者能够用脚尖站立,4(08.33%)名患者不能用无支撑的患足脚尖站立,但能够用有支撑的患足脚尖站立,1(02.08%)名患者因严重感染和伤口裂开而不能用无支撑的患足站立。最终结果为:优-29(60.0%),良-14(30.0%),中-4(8.0%),差-1(2.0%)。OTAI 的修复并不困难,但早期诊断、正确的手术盥洗、精细的修复以及充分的术后管理是成功的关键。因此,根据这项研究的结果,治疗方案对外科医生来说简单易行,对患者来说方便便宜。
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Evaluation of Results of Primary Repair of Open Tendo-Achilles Injury in the Department of Casualty, MMCH, Bangladesh.

Achilles tendon injury has been increasing over recent years due to a variety of causes. The injury of the Achilles tendon is a disabling condition, which is difficult to treat if there is a gap or defect between the two ends of the disrupted tendon. Patients with a rupture of the Achilles tendon should be operated without delay. Most of the people in our country use flat pan in the latrine, which are at a same level of the toilet floor. Surface of the toilet pan breaks down and cause sharp cut. Some of the cases of open tendon injuries occur due to road traffic accident, cut by broken glass and also assault. It is generally accepted that surgical repair of fresh ruptures of the Achilles tendon gives excellent results. Objective of the study was to find out the evaluation of the results of primary repair of Open tendo-achilles injury (OTAI). This prospective study was done in the department of Casualty of Mymensingh Medical College Hospital, Bangladesh in the period of Octy 2021 to June 2022. Patients who came with OTAI in casualty department were selected randomly. All cases were selected as OTAI, without associated injury of other leg muscles, posterior tibial artery and nerve within 12 hours. All patients underwent primary end to end repair by Modified Kessler's method. Evaluation of the results of primary repair of OTAI were carried out and were find out the common causes of injury, age and sex incidence, level of injury and to proposed a protocol for treating such cases in comfortable, cheap and convenient way for the patients. Operations were done at Casualty operation theatre (COT). Then 48 patients were followed up at the Department of Casualty. Among them 43(89.58%) of patients were able to stand on tip toes, 4(08.33%) of patients were not stand on tip toes of affected foot unsupported but able to stand on tip toes supported, 1(02.08%) of patients failed to stand on affected foot unsupported due to severe infection and wound gap. Final result were Excellent - 29(60.0%), Good - 14(30.0%), Fair - 4(8.0%), Poor - 1(2.0%). Repair of OTAI is not difficult but early diagnosis, proper surgical toileting, meticulous repair; adequate post-operative management is the key of success. So, the result of this study, treatment protocol can be followed, which is easy for surgeon and convenient and cheap for the patients.

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