Jiang Xian-Jun, Shen Jian-Jian, Huang Jie-Feng, Tong Pei-Jian
1 The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, China.
2 Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019832717. doi: 10.1177/2309499019832717.
Reconstruction of Myerson type III (defect size more than 5 cm) chronic Achilles tendon ruptures (CATRs) is a surgical challenge due to its large Achilles tendon defect. This study aims to describe our operative technique for Myerson type III CATR and its clinical outcomes.
From May 2012 to April 2015, we treated seven patients (6 males, 1 female) with Myerson type III CATR using semitendinosus tendon and gracilis tendon autograft. The mean age was 47.3 years (range: 37-56). Patients were followed for a mean time of 31.3 months. All patients' defect size between Achilles ends after debridement was more than 5 cm and hence classified as Myerson type III. The clinical outcomes were evaluated by visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Achilles tendon total rupture score (ATRS), and the Short Form 36 (SF-36).
All patients reported good postoperative clinical outcomes. The average AOFAS score increased from 54.29 points (range: 46-65 points) preoperatively to 97.57 points (range: 90-100 points) at last follow-up. The average ATRS increased from 51.43 points (range: 40-61 points) preoperatively to 92.71 points (range: 83-100 points) at last follow-up. And the average VAS for pain was 0 at the last follow-up. The mean value of SF-36 physical increased from 32.14 points (range: 25-35 points) to 90 points (range: 80-95 points). And the mean value of SF-36 mental was improved from 37.14 points (range: 32-40 points) to 90.86 points (range: 84-96 points).
Semitendinosus tendon combined gracilis tendon autograft is a safe and effective technique in the reconstruction of Myerson type III CATR.
迈尔森III型（缺损尺寸超过5厘米）慢性跟腱断裂（CATR）的重建是一项外科挑战，因其跟腱缺损较大。本研究旨在描述我们用于迈尔森III型CATR的手术技术及其临床结果。
2012年5月至2015年4月，我们使用半腱肌肌腱和股薄肌肌腱自体移植治疗了7例迈尔森III型CATR患者（6例男性，1例女性）。平均年龄为47.3岁（范围：37 - 56岁）。患者平均随访时间为31.3个月。所有患者清创后跟腱两端之间的缺损尺寸均超过5厘米，因此归类为迈尔森III型。通过视觉模拟评分法（VAS）评估疼痛、美国矫形足踝协会（AOFAS）踝关节和后足评分、跟腱完全断裂评分（ATRS）以及简明健康状况调查量表（SF - 36）来评估临床结果。
所有患者术后临床结果均良好。末次随访时，平均AOFAS评分从术前的54.29分（范围：46 - 65分）提高到97.57分（范围：90 - 100分）。平均ATRS评分从术前的51.43分（范围：40 - 61分）提高到末次随访时的92.71分（范围：83 - 100分）。末次随访时疼痛的平均VAS评分为0。SF - 36身体维度的平均值从32.14分（范围：25 - 35分）提高到90分（范围：80 - 95分）。SF - 36心理维度的平均值从37.14分（范围：32 - 40分）提高到90.86分（范围：84 - 96分）。
半腱肌肌腱联合股薄肌肌腱自体移植是重建迈尔森III型CATR的一种安全有效的技术。
