[1]冯杰,宋鹏,刘德臣,等.3种急性跟腱止点断裂修复方式的对比研究[J].中医正骨,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种急性跟腱止点断裂修复方式的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年05期
页码:
13-18
栏目:
基础研究
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:
冯杰1; 宋鹏2; 刘德臣2; 曹玉净2
1.河南中医药大学骨伤学院,河南 郑州 450002; 2.河南省中医院,河南 郑州 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
关键词:
腱损伤;  跟腱;  重建;  动物实验
Keywords:
tendon injuries;  Achilles tendon;  reconstruction;  animal experimentation
摘要:
目的:比较3种急性跟腱止点断裂修复方式的治疗效果。方法:选取56只5周龄SPF级雄性SD大鼠,随机分为4组,每组14只。适应性喂养1周后,将其中3组大鼠双侧后肢跟腱自止点处锐性离断,然后分别采用面缝合(面缝合组)、点缝合(点缝合组)及穿隧道缝合(穿隧道缝合组)的方式修复断裂的跟腱; 另外1组(空白组)经相同入路暴露跟腱但不离断,然后缝合切口。术后1周和4周,分别从各组随机选取7只大鼠,测定踝关节疼痛评分、血清白细胞介素(interleukin,IL)-1β水平、跟腱最大破坏载荷,并于术后4周时进行跟腱组织病理学观察。结果:①踝关节疼痛评分。术后1周时,面缝合组、点缝合组及穿隧道缝合组的踝关节跖屈、背伸疼痛评分均高于空白组(跖屈:P=0.000,P=0.000,P=0.000; 背伸:P=0.000,P=0.000,P=0.000); 面缝合组和点缝合组的踝关节跖屈疼痛评分均高于穿隧道缝合组(P=0.000,P=0.019); 面缝合组的踝关节背伸疼痛评分高于穿隧道缝合组(P=0.001); 其余各组踝关节跖屈、背伸疼痛评分两两比较,组间差异均无统计学意义。术后4周时,面缝合组、点缝合组及穿隧道缝合组的踝关节跖屈、背伸疼痛评分均高于空白组(跖屈:P=0.000,P=0.000,P=0.000; 背伸:P=0.000,P=0.000,P=0.000)。面缝合组的踝关节跖屈疼痛评分高于穿隧道缝合组(P=0.044); 面缝合组和点缝合组的踝关节背伸疼痛评分均高于穿隧道缝合组(P=0.024,P=0.000); 其余各组踝关节跖屈、背伸疼痛评分两两比较,组间差异均无统计学意义。②血清IL-1β水平。术后1周、4周时,面缝合组、点缝合组及穿隧道缝合组的血清IL-1β水平均高于空白组(术后1周:P=0.000,P=0.000,P=0.000; 术后4周:P=0.000,P=0.000,P=0.000)。术后1周时,穿隧道缝合组的血清IL-1β水平高于面缝合组和点缝合组(P=0.003,P=0.001); 面缝合组和点缝合组血清IL-1β水平的差异无统计学意义(P=0.542)。术后4周时,面缝合组、点缝合组及穿隧道缝合组血清IL-1β水平的组间差异均无统计学意义(P=0.864,P=0.622,P=0.748)。③跟腱最大破坏载荷。术后1周、4周时,面缝合组、点缝合组及穿隧道缝合组的跟腱最大破坏载荷均低于空白组(术后1周:P=0.000,P=0.000,P=0.000; 术后4周:P=0.000,P=0.000,P=0.000)。术后1周时,穿隧道缝合组的跟腱最大破坏载荷高于面缝合组(P=0.023); 点缝合组与面缝合组、穿隧道缝合组跟腱最大破坏载荷的差异均无统计学意义(P=0.779,P=0.053)。术后4周时,穿隧道缝合组的跟腱最大破坏载荷高于面缝合组(P=0.011); 点缝合组与面缝合组、穿隧道缝合组跟腱最大破坏载荷比较,组间差异均无统计学意义(P=0.154,P=0.217)。④跟腱组织病理学观察结果。HE染色结果显示,术后4周时空白组大鼠跟腱组织结构正常,肌纤维排列紧密,未见明显变性,周围可见纤维结缔组织,未见炎症细胞浸润; 面缝合组大鼠跟腱组织结构中度异常,结缔组织致密,可见少量炎症细胞浸润及少量新生血管; 点缝合组大鼠跟腱组织结构中度异常,肌纤维数量增多,部分区域间隙增大,可见纤维组织及少量炎症细胞浸润,并可见少量新生血管; 穿隧道缝合组大鼠跟腱组织结构轻度异常,结缔组织致密,可见大量炎症细胞浸润,新生血管数量较少。结论:与面缝合和点缝合相比,采用穿隧道缝合修复急性跟腱止点断裂,可获得更好的生物力学稳定性,但创伤较大。
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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备注/Memo

备注/Memo:
基金项目:河南省中医药科学研究专项课题(2023ZY1008); 河南省重点研发与推广专项课题(222102310568)
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更新日期/Last Update: 1900-01-01