Release of gastrocnemius aponeurosis and suture of the Achilles tendon end scar tissue managing the chronic Achilles tendon rupture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of scar tissue suture at the broken end of Achilles tendon after gastrocnemius aponeurosis release in the treatment of chronic Achilles tendon rupture.@*METHODS@#The clinical data of 17 patients with old achilles tendon rupture treated from January 2017 to December 2019 were analyzed retrospectively, including 15 males and 2 females, aged 26 to 53 years with an average of (35.2±11.6) years old, and the time from injury to operation was 37 to 92 days with an average of (49.3±13.3) days. Myerson's classification included 6 cases of typeⅡ and 11 cases of typeⅢ. The defect of the broken end of Achilles tendon was 2 to 5 cm with an average of(4.1±1.5) cm after partial scar tissue was removed. All patients were treated with gastrocnemius aponeurosis, appropriate excision of scar tissue at the broken end of Achilles tendon and direct suture. The continuity and healing of Achilles tendon were evaluated by color Doppler ultrasound 3 months after operation. The ankle plantar flexor strength was measured by ankle plantar flexor strength tester before operation and 1 year after operation. American Orthopaedic Foot and Ankle Society ankle hindfoot score (AOFAS) and Achilles tendon rupture score were used before operation and 1 year after operation Achilles tendon total fracture score (ATRS) was used to evaluate the clinical rehabilitation of Achilles tendon rupture.@*RESULTS@#All patients were followed up for 12 to 18 months with an average of(13.6±1.8) months. The surgical incision healed in stageⅠ. Color Doppler ultrasound showed good continuity of Achilles tendon, local Achilles tendon slightly thickened and irregular fiber direction. The ankle plantar flexor force (92.2±3.9) N at 1 year after operation was significantly higher than that before operation (29.5±4.2) N (P<0.05);One year after operation, the AOFAS(91.20±3.30) was significantly higher than that before operation (42.20±4.40)(P<0.05);the ATRS (90.70±3.00) was significantly higher than that before operation(40.00±2.90)(P<0.05).@*CONCLUSION@#The gastrocnemius aponeurosis release combined with scar suture of Achilles tendon end is an effective technique for the treatment of chronic Achilles tendon rupture, avoid injury to hallux flexor longus or flexor digitorum longus, with the plantar flexor muscle strength of the ankle was recovered well, is an effective method to treat chronic Achilles tendon rupture.

Clinical observation of the low molecular weight heparin calcium combined with Yinxing Damo injection on the prevention of deep venous thrombosis after the operation of intertrochanteric fracture / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of the low molecular weight heparin calcium (LMWHC) combined with Yinxin Damo Injection (YDI) on the prevention of deep venous thrombosis (DVT) after the operation of intertrochanteric fracture.</p><p><b>METHODS</b>Sixty-two patients with intertrochanteric fracture were randomly assigned to the control group and the combined group, 31 in each group. Patients in the control group were subcutaneously injected with 6 000 IU LMWHC, twice daily. On this basis of the aforesaid treatment, patients in the combined group were intravenously dripped with YDI at the daily dose of 20 mL, once daily. The treatment lasted for 10 days in both groups. The DVT incidence rate, postoperative drainage amount of blood, activated partial thromboplastin time (APTT), plasma prothrombin time (PT), platelet count, and the maximal swelling rate of lower limbs after surgery were compared between the two groups after operation.</p><p><b>RESULTS</b>In the control group DVT occurred in 5 cases (16. 1%) while it occurred in 2 cases (6.5%) in the combined group, showing significant differences (P < 0.05). Both APTT and PT were shortened in the two groups on the 2nd day after medication (P < 0.01). Compared with the control group, it was more obvious in the combined group, showing statistical significance (P < 0.05). Both APTT and PT were shortened in the control group on the 10th day after medication when compared with before treatment (P < 0.01). But they were postponed in the combined group when compared with before medication, showing statistical difference when compared with the control group (P < 0.05). The platelet count increased in the combined group on the 10th day after medication. Besides, it was higher than that in the control group, showing statistical difference (P < 0.05). The platelet counts were in the normal range.</p><p><b>CONCLUSIONS</b>LMWSC combined with YDI could not only reduce the incidence of DVT after the operation of intertrochanteric fracture, but also change the state of higher blood coagulation. It showed significant effect on preventing DVT after the operation of intertrochanteric fractures.</p>