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[1]馮杰,宋鵬,劉德臣,等.3種急性跟腱止點斷裂修復(fù)方式的對比研究[J].中醫(yī)正骨,2024,36(05):13-18.
　FENG Jie,SONG Peng,LIU Dechen,et al.A comparative study of three repairing methods for acute Achilles tendon ruptures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(05):13-18.
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3種急性跟腱止點斷裂修復(fù)方式的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年05期
頁碼:
13-18
欄目:
基礎(chǔ)研究
出版日期:
2024-05-20

文章信息/Info

Title:
A comparative study of three repairing methods for acute Achilles tendon ruptures
作者:
馮杰1; 宋鵬2; 劉德臣2; 曹玉凈2
1.河南中醫(yī)藥大學(xué)骨傷學(xué)院,河南 鄭州 450002; 2.河南省中醫(yī)院,河南 鄭州 450002
Author(s):
FENG Jie1; SONG Peng2; LIU Dechen2; CAO Yujing2
1.College of Orthopaedics and Traumatology of Henan University of Chinese Medicine,Zhengzhou 450002,Henan,China 2.Henan Province Hospital of TCM,Zhengzhou 450002,Henan,China
關(guān)鍵詞:
腱損傷;  跟腱;  重建;  動物實驗
Keywords:
tendon injuries;  Achilles tendon;  reconstruction;  animal experimentation
摘要:
目的:比較3種急性跟腱止點斷裂修復(fù)方式的治療效果。方法:選取56只5周齡SPF級雄性SD大鼠,隨機分為4組,每組14只。適應(yīng)性喂養(yǎng)1周后,將其中3組大鼠雙側(cè)后肢跟腱自止點處銳性離斷,然后分別采用面縫合(面縫合組)、點縫合(點縫合組)及穿隧道縫合(穿隧道縫合組)的方式修復(fù)斷裂的跟腱; 另外1組(空白組)經(jīng)相同入路暴露跟腱但不離斷,然后縫合切口。術(shù)后1周和4周,分別從各組隨機選取7只大鼠,測定踝關(guān)節(jié)疼痛評分、血清白細胞介素(interleukin,IL)-1β水平、跟腱最大破壞載荷,并于術(shù)后4周時進行跟腱組織病理學(xué)觀察。結(jié)果:①踝關(guān)節(jié)疼痛評分。術(shù)后1周時,面縫合組、點縫合組及穿隧道縫合組的踝關(guān)節(jié)跖屈、背伸疼痛評分均高于空白組(跖屈:P=0.000,P=0.000,P=0.000; 背伸:P=0.000,P=0.000,P=0.000); 面縫合組和點縫合組的踝關(guān)節(jié)跖屈疼痛評分均高于穿隧道縫合組(P=0.000,P=0.019); 面縫合組的踝關(guān)節(jié)背伸疼痛評分高于穿隧道縫合組(P=0.001); 其余各組踝關(guān)節(jié)跖屈、背伸疼痛評分兩兩比較,組間差異均無統(tǒng)計學(xué)意義。術(shù)后4周時,面縫合組、點縫合組及穿隧道縫合組的踝關(guān)節(jié)跖屈、背伸疼痛評分均高于空白組(跖屈:P=0.000,P=0.000,P=0.000; 背伸:P=0.000,P=0.000,P=0.000)。面縫合組的踝關(guān)節(jié)跖屈疼痛評分高于穿隧道縫合組(P=0.044); 面縫合組和點縫合組的踝關(guān)節(jié)背伸疼痛評分均高于穿隧道縫合組(P=0.024,P=0.000); 其余各組踝關(guān)節(jié)跖屈、背伸疼痛評分兩兩比較,組間差異均無統(tǒng)計學(xué)意義。②血清IL-1β水平。術(shù)后1周、4周時,面縫合組、點縫合組及穿隧道縫合組的血清IL-1β水平均高于空白組(術(shù)后1周:P=0.000,P=0.000,P=0.000; 術(shù)后4周:P=0.000,P=0.000,P=0.000)。術(shù)后1周時,穿隧道縫合組的血清IL-1β水平高于面縫合組和點縫合組(P=0.003,P=0.001); 面縫合組和點縫合組血清IL-1β水平的差異無統(tǒng)計學(xué)意義(P=0.542)。術(shù)后4周時,面縫合組、點縫合組及穿隧道縫合組血清IL-1β水平的組間差異均無統(tǒng)計學(xué)意義(P=0.864,P=0.622,P=0.748)。③跟腱最大破壞載荷。術(shù)后1周、4周時,面縫合組、點縫合組及穿隧道縫合組的跟腱最大破壞載荷均低于空白組(術(shù)后1周:P=0.000,P=0.000,P=0.000; 術(shù)后4周:P=0.000,P=0.000,P=0.000)。術(shù)后1周時,穿隧道縫合組的跟腱最大破壞載荷高于面縫合組(P=0.023); 點縫合組與面縫合組、穿隧道縫合組跟腱最大破壞載荷的差異均無統(tǒng)計學(xué)意義(P=0.779,P=0.053)。術(shù)后4周時,穿隧道縫合組的跟腱最大破壞載荷高于面縫合組(P=0.011); 點縫合組與面縫合組、穿隧道縫合組跟腱最大破壞載荷比較,組間差異均無統(tǒng)計學(xué)意義(P=0.154,P=0.217)。④跟腱組織病理學(xué)觀察結(jié)果。HE染色結(jié)果顯示,術(shù)后4周時空白組大鼠跟腱組織結(jié)構(gòu)正常,肌纖維排列緊密,未見明顯變性,周圍可見纖維結(jié)締組織,未見炎癥細胞浸潤; 面縫合組大鼠跟腱組織結(jié)構(gòu)中度異常,結(jié)締組織致密,可見少量炎癥細胞浸潤及少量新生血管; 點縫合組大鼠跟腱組織結(jié)構(gòu)中度異常,肌纖維數(shù)量增多,部分區(qū)域間隙增大,可見纖維組織及少量炎癥細胞浸潤,并可見少量新生血管; 穿隧道縫合組大鼠跟腱組織結(jié)構(gòu)輕度異常,結(jié)締組織致密,可見大量炎癥細胞浸潤,新生血管數(shù)量較少。結(jié)論:與面縫合和點縫合相比,采用穿隧道縫合修復(fù)急性跟腱止點斷裂,可獲得更好的生物力學(xué)穩(wěn)定性,但創(chuàng)傷較大。
Abstract:
Objective:To compare the outcomes of three methods for repairing acute Achilles tendon ruptures(ATRs).Methods:Fifty-six 5-week-old specific pathogen-free(SPF)-grade male Sprague-Dawley(SD)rats were selected and randomized into 4 groups,14 cases in each group.After adaptive feeding for one week,the rats in any three groups were subjected to surgeries for building models by sharply transecting the Achilles tendons of bilateral hindlimbs from the insertion site,after successful modeling,the ruptured Achilles tendons were repaired by using surface suture(surface suture group),point suture(point suture group),and transosseous suture(transosseous suture group),respectively; while,the ones in the remained group(blank group)underwent surgeries for merely exposing(through the same approach)but not transecting the Achilles tendons,followed by sewing up the incision.At postoperative week 1 and 4,7 rats were randomly selected from each group for measuring the ankle pain score,serum interleukin(IL)-1β level,and ultimate load to failure in Achilles tendon,moreover,the histopathological changes in Achilles tendon was observed at postoperative week 4.Results:①At postoperative week 1,the ankle plantar flexion and dorsal extension pain scores were higher in surface suture group,point suture group and transosseous suture group compared to blank group(plantar flexion:P=0.000,P=0.000,P=0.000; dorsal extension:P=0.000,P=0.000,P=0.000); the ankle plantar flexion pain score was higher in surface suture group and point suture group compared to transosseous suture group(P=0.000,P=0.019); the ankle dorsal extension pain score was higher in surface suture group compared to transosseous suture group(P=0.001); further pairwise comparison in the ankle plantar flexion and dorsal extension pain scores among the rest groups showed no statistical significance.At postoperative week 4,the ankle plantar flexion and dorsal extension pain scores were higher in surface suture group,point suture group and transosseous suture group compared to blank group(plantar flexion:P=0.000,P=0.000,P=0.000; dorsal extension:P=0.000,P=0.000,P=0.000); the ankle plantar flexion pain score was higher in surface suture group compared to transosseous suture group(P=0.044); the ankle dorsal extension pain score was higher in surface suture group and point suture group compared to transosseous suture group(P=0.024,P=0.000); further pairwise comparison in the ankle plantar flexion and dorsal extension pain scores among the rest groups showed no statistical significance.②At postoperative week 1 and 4,the serum level of IL-1β was higher in surface suture group,point suture group and transosseous suture group compared to blank group(postoperative week 1:P=0.000,P=0.000,P=0.000; postoperative week 4:P=0.000,P=0.000,P=0.000); At postoperative week 1,the serum level of IL-1β was higher in transosseous suture group compared to surface suture group and point suture group(P=0.003,P=0.001),while there was no statistical difference between surface suture group and point suture group(P=0.542); At postoperative week 4,there was no statistical difference in serum level of IL-1β among surface suture group,point suture group and transosseous suture group(P=0.864,P=0.622,P=0.748).③At postoperative week 1 and 4,the ultimate load to failure in Achilles tendon was smaller in surface suture group,point suture group and transosseous suture group compared to blank group(postoperative week 1:P=0.000,P=0.000,P=0.000; postoperative week 4:P=0.000,P=0.000,P=0.000).At postoperative week 1,the ultimate load to failure in Achilles tendon was greater in transosseous suture group compared to surface suture group(P=0.023); there was no statistical difference in ultimate load to failure in Achilles tendon between point suture group and surface suture group and between point suture group and transosseous suture group(P=0.779,P=0.053).At postoperative week 4,the ultimate load to failure in Achilles tendon was greater in transosseous suture group compared to surface suture group(P=0.011); there was no statistical difference in ultimate load to failure in Achilles tendon between point suture group and surface suture group and between point suture group and transosseous suture group(P=0.154,P=0.217).④The results of HE staining showed that,at postoperative week 4,the normal structure,with tightly arranged muscle fibers(without obvious degeneration)and visible fibrous connective tissues(without infiltration by inflammatory cells),were observed in Achilles tendon tissues of rats from blank group; the moderately abnormal structure,manifesting as dense connective tissue,mild infiltration by inflammatory cells and slight neovascularization,was observed in Achilles tendon tissues of mo-del rats from surface suture group; the moderately abnormal structure,with increased muscle fibers,enlarged gaps in some areas,visible fibrous tissue,mild infiltration by inflammatory cells,and slight neovascularization,were observed in Achilles tendon tissues of model rats from point suture group; the slightly abnormal structure,manifesting as dense connective tissue,massive infiltration by inflammatory cells,and slight neovascularization,was observed in Achilles tendon tissues of model rats from transosseous suture group.Conclusion:The transosseous suture can achieve better biomechanical stability in repairing acute ATRs compared to surface suture and point suture,while,it leads to greater trauma compared the latter two.

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備注/Memo

備注/Memo:
基金項目:河南省中醫(yī)藥科學(xué)研究專項課題(2023ZY1008); 河南省重點研發(fā)與推廣專項課題(222102310568)
通訊作者:曹玉凈 E-mail:[email protected]
更新日期/Last Update: 1900-01-01