兔跟腱断裂修复的实验病理研究

作者运用兔跟腱体外培养的实验模型，证实了在跟腱愈合过程中，腱围组织起着关键性的桥接作用。虽然在横断的肌腱部分，腱细胞也有试图修复的表现，但如没有腱围组织的参与，跟腱的愈合将可能是不完全的。根据实验结果，作者提出在进行跟腱修复手术时，一定要尽可能保留腱围组织以利于跟腱的愈合。     

陈旧跟腱断裂的临床病理研究

目的 :了解陈旧跟腱断裂患者的跟腱断端及其周围腱组织和肌肉组织的病理改变情况。材料和方法 :对3 0例陈旧跟腱断裂者的跟腱断端及其周围的腱组织和肌肉组织进行了术中的大体病理观察 ;对其中的 12例患者的断端及附近的腱组织和肌肉组织还进行了光镜、电镜的形态学观察 ,并用ABC免疫组化法了解了这些部位的表皮生长因子 (EGF)和成纤维细胞生长因子 (FGF)的表达情况。结果 :( 1)陈旧跟腱断裂的断端有滑囊存在 ,滑囊的出现率是4 3 3 %。 ( 2 )陈旧跟腱断裂所累及的不仅仅是跟腱本身 ,还可伴有小腿三头肌的变性、坏死改变。 ( 3 )跟腱陈旧断端的异常EGF的自分泌和旁分泌是导致跟腱断端大量毛细血管增生、血管内皮细胞增生和管腔狭窄、纤维结缔结组织增生的主要原因 ,FGF在其中所起的作用还有待进一步阐明。结论 :陈旧跟腱断裂的病理改变所累及的不仅是跟腱本身 ,还累及其附近的肌肉组织。避免误诊、减少陈旧跟腱断裂的发生 ,不仅可以避免肌肉组织变性坏死等不必要的并发症 ,而且可以促进术后患者的早日康复并提高对跟腱断裂手术疗效。     

飞行人员跟腱断裂7例

目的:为飞行人员的常见运动外伤探讨对策。方法:均在入院第2 d完成手术,配合6个月左右的康复训练。结果:复查MRI证实跟腱愈合良好,跟腱功能恢复正常,随访1～5年对飞行无影响。结论:跟腱断裂采取手术治疗效果可靠;建议飞行人员认真做好训练前的热身活动,杜绝带伤运动,对避免跟腱断裂的发生具有重要作用。     

不同途径补锌对烫伤大鼠血清、组织中锌的影响

锌是体内最重要的微量元素之一 ,烧伤后锌经创面、尿液大量丢失 ,机体处于缺锌状态 ,引起许多病理变化[1] 。本实验主要观察了烫伤大鼠经不同途径补锌后血清及组织中锌含量的变化 ,为烧伤病人补锌提供实验依据。1　材料与方法1 1　动物分组　ＳＤ大鼠 80只 ,雄性 ,体重 ( 6 0± 3) ｇ ,随机分成 4组 ,Ｃ组 (对照组 ) 8只 ,Ｎ组 (正常组 )、Ｈ组 (口饲补锌组 )、Ｗ组 (创面补锌组 )各 2 4只。大鼠单独置于透明塑料笼内 ,乙醚麻醉Ｃ组大鼠 ,心外穿刺抽血活杀 ,留取全血、肝脏、股骨、烫伤皮肤。其他 3组乙醚麻醉后 ,10 %硫化钠背部脱毛 ,10 0…     

缺锌对大鼠力竭性游泳前后睾酮和锌水平变化的影响

本实验动态观察了缺锌和缺锌后补锌对大鼠力竭性游泳前后辜丸和血清睾酮、锌水平以及游泳能力的影响。结果显示：缺锌造成大鼠游泳能力大大降低，补锌后明显增加。不论安静时还是力竭性游泳后１２小时内，缺锌大鼠的血清和辜丸锌含量均显著低于对照和补锌大鼠。与对照和补锌大鼠相比，缺锌大鼠的血清和睾丸酮含量，安静时均较低，力竭性游泳后也呈现不同程度的降低。缺锌还造成大鼠辜丸重量的明显下降。结果表明，锌营养不良将损害运动能力。     

跟腱断裂的术后护理与康复指导

为了提高跟腱断裂患者术前、术后的护理水平及术后康复水平 ,对我所 1 985～ 1 999年3 0 7例跟腱断裂患者的护理和康复进行总结 ,指出 :术前、术后护理的重点问题及康复要点包括心理护理、患足护理、防止跟腱再断裂、术后康复指导等 ;跟腱断裂术后跟腱再断裂多发生于术后早期 ,均与意外摔倒或未按康复计划执行有关 ;感染一般发生于术后 1 0～3 0天 ,合理换药可使伤口较早愈合 ;跟腱断裂手术前后及时给予合理的护理及康复指导 ,对防止术后并发症的发生及术后早日康复非常重要。     

局部注射糖皮质激素对运动员跟腱断裂的影响

目的 :了解使用糖皮质激素对运动员慢性跟腱周围炎进行局部封闭治疗过程中 ,糖皮质激素对跟腱断裂的影响。方法 :对 9例曾反复多次使用糖皮质激素进行局部封闭的跟腱断裂运动员的手术治疗、术中所见、手术疗效评定和术后康复情况进行归纳总结 ,并探讨糖皮质激素在此过程中可能起的作用。结果 :本组 9例 ,占同期 17例跟腱断裂运动员的 5 2 94% ;术中见跟腱变性较严重 ,范围广 ,断端直接吻合困难 ;手术疗效优 6例 ,良 2例 ,差 1例 ;术后康复期相对较长 ,2例在康复过程跟腱出现再断裂。结论 :反复多次局部注射糖皮质激素对运动员跟腱断裂具有负面影响 ,会加重跟腱的缺血和变性 ,使跟腱更易于断裂 ;对该种类型的运动创伤应首选手术治疗 ;术后合理的康复和心理治疗同样是取得满意疗效的关键。     

高频超声快速诊断急性闭合跟腱断裂临床价值

目的探讨高频超声在快速诊断急性闭合跟腱断裂中的应用价值。方法对急诊收治急性闭合跟腱断裂的100例患者进行高频超声检查,观察损伤跟腱的形态、内部结构及回声改变,判断跟腱损伤程度并将超声诊断结果与急诊手术结果相比较。结果急诊手术结果显示,跟腱完全性断裂85例,高频超声快速诊断均检出,诊断符合率为100%。不完全断裂14例,高频超声漏诊3例,诊断符合率80%。漏诊3例均为微小部分断裂,后被MRI确诊。误诊1例,疑似为跟腱微小囊肿,误诊率1%。结论高频超声可快速诊断急性闭合跟腱断裂,是一种便捷、经济、可靠、无创的诊断方法,为断裂跟腱快速急诊手术提供临床依据。     

飞行员跟腱断裂的治疗与预防

目的 探讨飞行员跟腱断裂的损伤因素,提出预防办法。方法对跟腱断裂飞行员行急诊改良的Kleinert直接缝合法加“+”字侧方加强法手术修复。对于有缺损的行“V-Y”延长术,切除跟腱炎引起的变性组织,采用同种异体肌腱移植修复。术后用石膏固定,进行功能康复锻炼。结果 飞行员跟腱断裂多为剧烈的体育锻炼中腓肠肌突然急剧收缩所致,均为闭合性。按严庆水治疗效果标准评定术后1～5年的疗效:优9例,良3例,可1例,差者无。未发生再断裂者。结论 诊断明确急诊手术治疗是功能恢复、提高飞行员参训率的有力保证。运动前进行热身准备活动是减少和防止跟腱损伤的首要措施。     

肌肉包埋法旷置大段裸露跟腱的初步报告

目的 探讨肌肉包埋法旷置大段裸露跟腱的手术方法和疗效.方法 本组21例跟腱断裂合并跟区皮肤缺损,16例合并胫腓骨粉碎骨折及动脉、神经损伤,13例合并休克,6例合并骨盆骨折,2例合并同侧开放性股骨骨折,3例合并肝脾破裂.急诊手术固定骨折,修复动脉、神经损伤,修复肝脾破裂;清创后小腿三头肌包埋、旷置跟腱.二次手术修复跟腱和跟区皮肤缺损.结果 跟腱与肌肉组织紧密粘连,外膜新鲜有光泽,腱性组织坚韧有力,无变黑、坏死、液化和感染.二次手术后随访15～27个月,平均18个月.疗效评定为优15例,良4例,差2例,优良率为90%.皮瓣均成活,伤口Ⅰ期愈合,跟腱无再次断裂.结论 肌肉包埋法可以有效避免跟腱暴露所致的缺血坏死和感染,为Ⅱ期手术提供条件.     

强化循环训练促进跟腱组织塑形改建的实验研究

目的考察耐力运动训练过程中大鼠跟腱组织结构与生化成分的变化及不同训练模式与大鼠跟腱塑形改建规律的对应关系。方法120只8周龄雄性Wistar大鼠按训练方式、训练时间两因素析因设计以体重区组进行随机分组，训练方式有自由活动、中等负荷训练、强化训练、强化循环训练4个水平，训练时间有1、2、3、4、6、8周6个水平，共24组，每组5只。训练结束后切取跟腱组织，通过扫描电镜及透射电镜观察其超微结构，并应用碱解法测定强化循环训练组大鼠跟腱中羟脯氨酸的含量，以其代表胶原蛋白总量的变化；通过免疫组织化学染色的方法对该训练组大鼠跟腱组织中Ⅲ型胶原蛋白含量的动态变化进行半定量分析。结果在训练过程中，跟腱的组织结构出现由以损伤为主到修复重建占主导的动态变化，循环训练模式下损伤表现出现早，程度轻，持续时间最短。跟腱胶原蛋白总量在训练过程中保持不变，而Ⅲ型胶原的表达呈现训练早期增强，随塑形改建的进行又逐渐减弱的规律。在运动训练下肌腱组织的塑形改建过程中，胶原的新生与破坏，合成与降解是相平衡的过程。训练早期Ⅲ型胶原的含量增加提示应力作用下胶原代谢活动加速，促进组织结构发生改建。结论肌腱在运动训练中的塑形改建是通过其内部结构的重塑而非组织肥大来完成的。训练中负荷重复的次数较之单次负荷的大小对肌腱的塑形改建更具积极意义，强化循环训练可以加速跟腱的塑形改建。     

Microcirculation after Achilles tendon rupture correlates with functional and patient‐reported outcomes

Patients with acute Achilles tendon rupture (ATR ) display an extended healing process with varying clinical outcome. Poor microcirculatory blood flow has been suggested to be a significant factor for the healing process. However, whether microcirculation may predict healing outcome has been mostly unknown. Therefore, we investigated whether blood flow in the Achilles tendon may be associated with patient‐reported and functional outcomes after ATR . In vivo laser‐Doppler flowmetry was used to assess microvascular blood flow bilateral in the Achilles tendons, during post‐occlusive reactive hyperemia, of nine patients with acute total ATR at 2 weeks post‐operatively. At 3 months post‐operatively, patient‐reported outcome was assessed using Achilles tendon Total Rupture Score (ATRS ). At 1 year a uniform outcome score, Achilles Combined Outcome Score (ACOS ), was obtained by combining validated, independent, patient‐reported (ATRS ), and functional outcome (heel‐rise test) measures. An improved combined patient‐reported and functional outcome, ACOS , at 1 year was significantly correlated with higher maximum blood flow (r=.777, P =.040) in the injured limb. Furthermore, enhanced patient‐reported outcome, ATRS , at 3 months, was associated with an elevated ratio of maximum to resting blood flow (r=.809, P =.015) in the uninjured limb. Blood flow in early tendon healing is associated with long‐term patient‐reported and functional outcomes after ATR . The microcirculatory blood flow of both the healing and contralateral Achilles tendon seems to determine the healing potential after injury.     

The ultrasonographic appearance of the ruptured Achilles tendon during healing: a longitudinal evaluation of surgical and nonsurgical treatment,with comparisons to MRI appearance

This prospective, randomized trial compared healing characteristics of the Achilles tendon after surgical and nonsurgical treatment for complete rupture of the Achilles tendon. Fifty-eight patients were examined by ultrasonography after 6, 12, and 24 months and by magnetic resonance imaging after 12 months. A standardized protocol was used, and the outcome was correlated with clinical findings. Common findings 1 year after the injury were tendon thickening and moderate heterogeneity of the tendon. Peritendinous reactions, edema, and defects were present only in a minority of patients. There were no significant differences between the treatment groups in any of the evaluated parameters apart from the gliding function of the tendon, which was significantly less in the surgically treated group than in the nonsurgically treated group. No correlations were found between the radiological findings and the clinical parameters, such as muscle strength, endurance, and range of motion. We conclude that the roles of ultrasonography and magnetic resonance imaging during the healing process after Achilles tendon rupture are limited, due to a weak correlation with clinical findings.     

Arthroscopically assisted percutaneous repair of fresh closed achilles tendon rupture by Kessler's suture

BACKGROUND: Achilles tendon ruptures are difficult to repair, and the healing rate is low due to this structure's anatomic and physiological characteristics. It is essential to develop new techniques to increase the healing rate and decrease the rate of complications. OBJECTIVE: To propose and evaluate a new percutaneous method of repairing fresh closed Achilles tendon ruptures by Kessler's suture under arthroscopy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty patients were followed at least 12 months in this study. First, the torn ends of the Achilles tendon were debrided during arthroscopy. Then percutaneous repair of the Achilles tendon was performed using Kessler's suture by an inside-out technique. All cases were followed up for an average range of 21 months (range, 12-36 months). All patients were evaluated by clinical examination, magnetic resonance imaging, and the Lindholm scale. RESULTS: The torn ends were well aligned and sutured after the debridement under arthroscopy. According to the Lindholm scale, excellent results were seen in 15 cases and good in 5 cases. No patients had complications such as nerve injury, infection, or re-rupture at follow-up. Magnetic resonance imaging results showed that the ruptured Achilles tendons were repaired and remodeled very well in all patients. CONCLUSION: The present method is an effective surgical technique for repair of a closed rupture of the Achilles tendon. The short-term follow-up results were good, and recovery time was short. Few complications were found in our study cases.     

磁共振成像在飞行人员闭合性跟腱损伤诊断中的应用（摘要）

目的探讨磁共振成像在飞行人员闭合性跟腱损伤的应用价值,为临床诊断提供影像学依据。方法对经手术证实的7例飞行人员闭合性跟腱损伤病例的磁共振成像表现进行回顾性分析。结果术前7例病人的磁共振成像诊断分别为跟腱断裂（2例）和不完全断裂（5例）,手术结果与磁共振成像诊断相一致。     

通道辅助微创与切开跟腱缩短术治疗陈旧性跟腱过长的疗效比较

目的 比较通道辅助微创跟腱缩短术与切开跟腱缩短术治疗陈旧性跟腱断裂愈合后跟腱过长的疗效.方法 回顾分析2013年12月-2015年12月符合入选标准的19例患者的临床资料,其中8例采用通道辅助微创跟腱缩短术,11例采用切开Krackow跟腱缩短术.两组患者性别、年龄、受伤至手术时间、术前小腿周径、术前美国矫形足踝协会(AOFAS)评分等一般资料差异无统计学意义(P>0.05),具有可比性.比较两组的手术时间、手术切口长度、术后住院时间,术后跟腱恢复情况,小腿周径和AOFAS评分.结果 微创组手术时间、手术切口长度及术后住院时间均显著少于切开组(P<0.05).术后8周随访时MRI显示两组患者跟腱均恢复连续性.两组末次随访时小腿周径和AOFAS评分均高于术前,差异有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05).结论 通道辅助微创缩短术治疗陈旧性跟腱断裂愈合后跟腱过长的疗效与切开跟腱缩短术相似,且具有手术时间短、切口小、住院时间短、可避免腓肠神经损伤等优点.     

Negative effects of parecoxib and indomethacin on tendon healing: an experimental study in rats

Conventional non-steroidal anti-inflammatory drugs (NSAIDs) and newer specific cyclooxygenase-2 (cox-2) inhibitors are commonly used in muscular skeletal trauma and in relation to orthopedic surgery to reduce the inflammatory response and pain. Studies have indicated that these drugs can have a negative effect on tendon healing in the early proliferative phase, but might be beneficial in the remodeling phase when inflammation might impede healing. Our study was designed to investigate if short-term administration of cox inhibitors after injury or postoperatively might have negative effects on the tendon healing. The right Achilles tendon of 60 rats was cut transversely, a 3 mm long segment of the tendon was removed and left unrepaired. The animals were then given parecoxib, indomethacin or saline intraperitoneally twice daily for 7 days. After 14 days, the animals were euthanized. The transverse and sagittal diameters in the healing area were measured and mechanical testing of the tensile strength of the tendons was performed. We found a significantly lower tensile strength in rats given both parecoxib and indomethacin compared to the control group. Stiffness in the healing tendons was significantly lower in the parecoxib group compared to both the placebo and the indomethacin groups. The transverse and sagittal diameters of the tendons were reduced in both the parecoxib and indomethacin groups. Both parecoxib and indomethacin impaired tendon healing; the negative effect was most pronounced with parecoxib.     

Calf muscle atrophy and Achilles tendon healing following experimental tendon division and surgery in rats

We used a rat model to study the effects of immobilization of the calf muscle-tendon complex after an experimental Achilles tendon repair. Immobilizations of the complex in either a relaxed or tensioned position were compared by histochemical and morphometric analyses at the site of the tendon injury as well as in the gastrocnemius and soleus muscle bellies. The type of immobilization did not affect the healing of the tendon injury because no reruptures occurred in either of the treatment groups and the average tendon end-to-end distance did not differ between the groups. However, immobilization in a relaxed position led to a significantly more extensive fiber atrophy in the calf muscles. In clinical practice, these results suggest that rehabilitation after Achilles tendon surgery can be early and gradually tension- and load-increasing without a significant increase in the risk of rerupture of the tendon.