紧密缝合缩短跟腱增生愈合瘢痕组织修复Myerson Ⅲ型陈旧性跟腱断裂的疗效分析

Efficacy of tight suturing for shortening healing scar tissues in repair of Myerson type III old rupture of Achilles tendon

目的探讨紧密缝合缩短跟腱增生愈合瘢痕组织修复MyersonⅢ型陈旧性跟腱断裂的临床疗效。方法采用回顾性病例系列研究分析2015年1月—2017年12月成都体育学院附属体育医院收治的16例MyersonⅢ型陈旧性跟腱断裂患者的临床资料,患者均为男性;年龄19~71岁,平均40.6岁。致伤原因均为运动伤。跟腱断端缺损5~7 cm,平均5.2 cm。均采用紧密缝合缩短跟腱增生愈合瘢痕组织进行修复。记录手术时间及手术创口大小。应用Amer-Lindholm标准和美国足踝外科协会(AOFAS)踝-后足评分法对临床疗效进行评价。同时观察有无感染、跟腱再断裂、提踵无力、肌力下降、踝关节功能障碍、跛行及腓肠神经损伤症状等并发症。结果所有患者获随访11~41个月,平均26个月。手术时间25~51 min,平均37 min。手术创口4~12 cm,平均7 cm。根据Amer-Lindholm标准:优14例,良2例,优良率为100%。AOFAS踝-后足评分由术前(42.7±6.8)分提高至末次随访的(95.1±4.9)分(P<0.05)。随访期间,无感染、跟腱再断裂、提踵无力、肌力下降、踝关节功能障碍、跛行及腓肠神经损伤症状等并发症出现。结论采用紧密缝合缩短跟腱增生愈合瘢痕组织修复MyersonⅢ型陈旧性跟腱断裂,术后跟腱功能评分显著提高,创口无感染,无并发症出现。

Objective To investigate the clinical efficacy of tight suturing for shortening healing scar tissues in repair of Myerson type III old rupture of Achilles tendon.Methods A retrospective case series study was performed to analyze the clinical data of 16 patients with Myerson III type chronic Achilles tendon ruptures admitted to Sports Hospital Affiliated to Chengdu Sport University from January 2015 to December 2017.All of the patients were males with sports injuries,aged 19-71 years(mean,40.6 years).The Achilles tendon defect was 5-7 centimeter(mean,5.2 centimeter).The patients received tight suturing and shortening healing scar tissue for the repair.The operation time and surgical wound size were recorded.The clinical efficacy was evaluated by Amer-Lindholm standard and American 0rthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score.Meanwhile,the complications such as wound infection,Achilles tendon re-rupture,heel lifting weakness,muscle strength decline,ankle dysfunction,lameness and symptoms of sural nerve injury were recorded.Results All patients were followed up for 11-41 months,with an average of 26 months.The operation time ranged from 25-51 minutes,with an average of 37 minutes.The incision was 4-12 cm,averaging 7 cm.According to the Amer-Lindholm standard,14 patients were graded as excellent and two were graded as good,with the excellent and good rate of 100%.AOFAS ankle-hindfoot score increased from(42.7±6.8)points before operation to(95.1±4.9)points at the last follow-up(P<0.05).During the follow-up,there were no complications such as infection,Achilles tendon rupture,heel lifting weakness,muscle strength decline,ankle joint dysfunction,lameness and gastrocnemial nerve injury.Conclusion For Myerson type III old rupture of Achilles tendon,tight suturing for shortening healing scar tissue can increase the postoperative function scores without wound infection or complications.