摘要目的:比较急性跟腱断裂开放修复术后不同外固定时长对康复效果的影响。方法:采用前瞻性队列研究分析2020年8月至2023年8月北京大学第三医院收治的单侧急性闭合性跟腱断裂患者的临床资料。根据术后外固定不同时长（0、2、4、6周），将患者分为A组（96例）、B组（347例）、C组（346例）和D组（105例）。患者均行相同的开放修复缝合术。A组术后即刻进行康复，其余组在外固定拆除后也接受相同的康复方案。比较4组单足提踵高度（OHRH）、轻度运动（LE）、关节活动度（ROM）恢复时长；术后2、4、6、8周视觉模拟评分（VAS）；术后6、8、10、12、14、16周跟腱完全断裂评分（ATRS）和美国足踝外科协会（AOFAS）踝-后足评分；术后并发症发生率。结果:共纳入单侧急性闭合性跟腱断裂患者894例，其中男869例，女25例；年龄18~60岁［（35.0±6.3）岁］。患者均获随访14~25个月［（19.0±3.0）个月］。OHRH恢复时长：A组、B组分别为12.0（12.0，12.0）周、12.0（10.0，12.0）周，均短于C组和D组的14.0（14.0，16.0）周、14.0（14.0，14.0）周（ P<0.05）；A组与B组、C组与D组差异均无统计学意义（ P>0.05）。LE恢复时长：A组、B组分别为18.0（18.0，18.0）周、18.0（16.0，18.0）周，均短于C组和D组的20.0（20.0，20.0）周、20.0（20.0，20.0）周（ P<0.05）；A组与B组、C组与D组差异均无统计学意义（ P>0.05）。ROM恢复时长：A组、B组分别为6.0（6.0，6.0）周、6.0（6.0，6.0）周，均短于C组和D组的8.0（8.0，10.0）周、10.0（10.0，10.0）周（ P<0.05）；A组与B组、C组与D组差异均无统计学意义（ P>0.05）。术后2周，B组、C组和D组VAS分别为2.0（1.0，2.0）分、2.0（1.0，2.0）分、2.0（1.5，2.0）分，均低于A组的5.0（5.0，5.0）分（ P<0.05）；B组、C组与D组差异均无统计学意义（ P>0.05）。术后4周，B组、C组和D组VAS分别为1.0（0，1.0）分、1.0（0，1.0）分、1.0（0.5，1.0）分，均低于A组的2.0（1.0，2.0）分（ P<0.05）；B组、C组与D组差异均无统计学意义（ P>0.05）。术后6周，4组VAS均为0（0，0）分，差异无统计学意义（ P>0.05）。术后8周，4组VAS均为0（0，0）分，A、B组较C、D组低（ P<0.05）；A组与B组、C组与D组差异均无统计学意义（ P>0.05）。术后6周，A组、B组ATRS分别为52.0（52.0，53.8）分、52.0（50.0，53.0）分，均高于C组和D组的41.0（38.0，43.0）分、19.0（18.0，20.0）分（ P<0.05）；C组高于D组（ P<0.05）；A组与B组差异无统计学意义（ P>0.05）。术后8周，A组ATRS为66.0（66.0，68.0）分，均高于B组、C组和D组的63.0（62.0，64.0）分、52.0（50.0，53.0）分、39.0（37.0，40.0）分（ P<0.05）；B组均高于C组、D组（ P<0.05）；C组高于D组（ P<0.05）。术后10周，B组ATRS为75.0（74.0，76.0）分，均高于A组、C组和D组的69.0（69.0，70.0）分、72.0（66.0，74.0）分、62.0（58.5，63.0）分（ P<0.05）；A组和C组均高于D组（ P<0.05）；A组与C组差异无统计学意义（ P>0.05）。术后12周，B组ATRS为84.0（82.0，85.0）分，均高于A组、C组和D组的75.0（75.0，77.0）分、79.0（72.0，81.0）分、72.0（71.0，73.0）分（ P<0.05）；A组和C组均高于D组（ P<0.05）；A组与C组差异无统计学意义（ P>0.05）。术后14周，B组ATRS为87.0（86.0，87.0）分，均高于A组、C组和D组的82.0（82.0，84.0）分、83.0（80.0，85.0）分、79.0（77.5，80.0）分（ P<0.05）；A组和C组均高于D组（ P<0.05）；A组与C组差异无统计学意义（ P>0.05）。术后16周，A组、B组ATRS分别为87.0（87.0，88.0）分、88.0（87.0，88.0）分，均高于C组和D组的86.0（85.0，87.0）分、84.0（83.0，85.0）分（ P<0.05）；C组高于D组（ P<0.05）；A组与B组差异无统计学意义（ P>0.05）。术后6周，A组、B组AOFAS踝-后足评分分别为94.0（94.0，95.0）分、95.0（94.0，96.0）分，均高于C组和D组的85.0（83.0，86.0）分、74.0（72.0，75.0）分（ P<0.05）；C组高于D组（ P<0.05）；A组与B组差异无统计学意义（ P>0.05）。术后8周，B组AOFAS踝-后足评分为100.0（99.0，100.0）分，均高于A组、C组和D组的94.0（94.0，95.0）分、92.0（90.0，93.0）分、83.0（82.0，84.0）分（ P<0.05）；A组均高于C组、D组（ P<0.05）；C组高于D组（ P<0.05）。术后10周，B组AOFAS踝-后足评分为100.0（100.0，100.0）分，均高于A组、C组和D组的98.0（98.0，98.0）分、98.0（96.8，99.0）分、96.0（95.0，97.0）分（ P<0.05）；A组和C组均高于D组（ P<0.05）；A组与C组差异无统计学意义（ P>0.05）。术后12周，A组、B组AOFAS踝-后足评分均为100.0（100.0，100.0）分，2组差异无统计学意义（ P>0.05），但均高于C组和D组的100.0（98.0，100.0）分、99.0（98.0，99.0）分（ P<0.05）；C组高于D组（ P<0.05）。术后14、16周，4组AOFAS踝-后足评分均为100.0（100.0，100.0）分，差异无统计学意义（ P>0.05）。术后伤口浅表感染12例，其中A组5例［5.2%（5/96）］，B组2例［0.6%（2/347）］，C组2例［0.6%（2/346）］，D组3例［2.9%（3/105）］（ P<0.01）；术后跟腱再断裂16例，其中A组9例［9.4%（9/96）］，B组4例［1.2%（4/347）］，C组3例［0.9%（3/105）］，D组0例（ P<0.01）。 结论:对于单侧急性跟腱断裂，与开放修复缝合术后外固定4周和6周相比，外固定2周可缩短重返运动时长、减轻疼痛、促进功能恢复，且不增加并发症发生的风险。

abstractsObjective:To compare the impacts of external fixation of different durations on rehabilitation outcomes after open repair of acute Achilles tendon rupture.Methods:A prospective cohort study was conducted to analyze the clinical data of patients with unilateral acute closed Achilles tendon rupture admitted to Peking University Third Hospital from August 2020 to August 2023. Patients were divided into Group A ( n=96), Group B ( n=347), Group C ( n=346), and Group D ( n=105) based on different postoperative immobilization durations (0, 2, 4 and 6 weeks, respectively). After all the patients received identical open repair procedure, Group A was rehabilitated immediately but the other groups were rehabilitated with the same protocol after removal of the external fixation. Four groups were compared in terms of recovery time of one-leg heel-rise height (OHRH), recovery time of light exercise (LE) in brisk walking and jogging and recovery time of range of motion (ROM). Visual analogue scale (VAS) scores were also compared at 2, 4, 6 and 8 weeks postoperatively. Achilles tendon total rupture score (ATRS) and American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were evaluated at 6, 8, 10, 12, 14 and 16 weeks postoperatively. Complications were recorded. Results:A total of 894 patients including 869 males and 25 females were included, aged 18-60 years [(35.0±6.3)years]. All the patients were followed up for 14-25 months [(19.0±3.0)months]. The recovery time of OHRH in Group A and B was 12.0(12.0, 12.0)weeks and 12.0(10.0, 12.0)weeks, shorter than those in Group C [14.0(14.0, 16.0)weeks] and D [14.0(14.0, 14.0)weeks] ( P<0.05), with no significant difference between Group A and B ( P>0.05) and between Group C and D ( P>0.05). The recovery time of LE in Group A and B was 18.0(18.0, 18.0)weeks and 18.0(16.0, 18.0)weeks, shorter than those in Group C [20.0(20.0, 20.0)weeks] and D [20.0(20.0, 20.0)weeks] ( P<0.05), with no significant difference between Group A and B ( P>0.05) and between Group C and D ( P>0.05). The recovery time of ROM in Group A and B was 6.0(6.0, 6.0)weeks and 6.0(6.0, 6.0)weeks, shorter than those in Group C [8.0(8.0, 10.0)weeks] and D [10.0(10.0, 10.0)weeks)] ( P<0.05), with no significant difference between Group A and B, and between Group C and D ( P>0.05). At 2 weeks postoperatively, the VAS scores were 2.0(1.0, 2.0)points, 2.0(1.0, 2.0)points, and 2.0(1.5, 2.0)points in Group B, C and D, lower than 5.0(5.0, 5.0)points in Group A ( P<0.05), with no significant difference among Group B, C, and D ( P>0.05). At 4 weeks postoperatively, the VAS scores were 1.0(0, 1.0)points, 1.0(0, 1.0)points, and 1.0(0.5, 1.0)points in Group B, C and D, lower than 2.0(1.0, 2.0)points in Group A ( P<0.05), with no significant difference among Group B, C, and D ( P>0.05). At 6 weeks postoperatively, the VAS score was 0(0, 0)points in all the 4 groups, with no significant difference among them ( P>0.05). At 8 weeks postoperatively, the VAS score was 0(0, 0)points, with lower scores in Group A and B than those in Group C and D ( P<0.05) but with no significant difference between Group A and B and between Group C and D ( P>0.05). At 6 weeks postoperatively, the ATRS scores were 52.0(52.0, 53.8)points and 52.0(50.0, 53.0)points in Group A and B, higher than 41.0(38.0, 43.0)points and 19.0(18.0, 20.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 8 weeks postoperatively, the ATRS scores were 66.0(66.0, 68.0)points in Group A, higher than 63.0(62.0, 64.0)points, 52.0(50.0, 53.0)points, and 39.0(37.0, 40.0)points in Group B, C and D ( P<0.05), with a higher score in Group B than those in Group C and D ( P<0.05) and a higher score in Group C than that in Group D ( P<0.05). At 10 weeks postoperatively, the ATRS score was 75.0(74.0, 76.0)points in Group B, higher than 69.0(69.0, 70.0)points, 72.0(66.0, 74.0)points, and 62.0(58.5, 63.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 12 weeks postoperatively, the ATRS score was 84.0(82.0, 85.0)points in Group B, higher than 75.0(75.0, 77.0)points, 79.0(72.0, 81.0)points, and 72.0(71.0, 73.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 14 weeks postoperatively, the ATRS score was 87.0(86.0, 87.0)points in Group B, higher than 82.0(82.0, 84.0)points, 83.0(80.0, 85.0)points, and 79.0(77.5, 80.0)points in Group A, C and D ( P<0.05), with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 16 weeks postoperatively, the ATRS scores were 87.0(87.0, 88.0)points and 88.0(87.0, 88.0)points in Group A and B, higher than 86.0(85.0, 87.0)points and 84.0(83.0, 85.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 6 weeks postoperatively, the AOFAS ankle-hindfoot scores were 94.0(94.0, 95.0)points and 95.0(94.0, 96.0)points in Group A and B, higher than 85.0(83.0, 86.0)points and 74.0(72.0, 75.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05) but with no significant difference between Group A and B ( P>0.05). At 8 weeks postoperatively, the AOFAS ankle-hindfoot scores were 100.0(99.0, 100.0)points in Group B, higher than 94.0(94.0, 95.0)points, 92.0(90.0, 93.0)points, and 83.0(82.0, 84.0)points in Group A, C and D ( P<0.05), with a higher score in Group A than those in Group C and D ( P<0.05) and a higher score in Group C than that in Group D ( P<0.05). At 10 weeks postoperatively, the AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points in Group B, higher than 98.0(98.0, 98.0)points, 98.0(96.8, 99.0)points, and 96.0(95.0, 97.0)points in Group A, C and D, with higher scores in Group A and C than that in Group D ( P<0.05) but with no significant difference between Group A and C ( P>0.05). At 12 weeks postoperatively, the AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points in both Group A and B, with no significant difference between them ( P>0.05), which was higher than 100.0(98.0, 100.0)points and 99.0(98.0, 99.0)points in Group C and D ( P<0.05), with a higher score in Group C than that in Group D ( P<0.05). At 14 and 16 weeks postoperatively, AOFAS ankle-hindfoot score was 100.0(100.0, 100.0)points, with no significant difference among all the groups ( P>0.05). Superficial wound infection occurred in 12 patients [5.2%(5/96) in Group A, 0.6%(2/347) in Group B, 0.6%(2/346) in Group C and 2.9%(3/105) in Group D] ( P<0.01) while rerupture occurred in 16 [9.4%(9/96) in Group A, 1.2% (4/347) in Group B, 0.9%(3/105) in Group C, and 0 patient in Group D] ( P<0.01). Conclusion:For patients with unilateral acute Achilles tendon rupture, two weeks of postoperative external fixation after open repair can shorten the time of returning sports, alleviate pain, and promote functional recovery, without increasing the risk of complications.