全镜下跟腱清理与止点增强治疗跟腱部分撕裂的Haglund综合征的疗效对比

目的 比较全关节镜下跟腱清理与跟腱止点增强重建治疗跟腱部分撕裂的Haglund综合征患者的临床疗效。方法 回顾性分析2016年1月至2021年3月在青县人民医院应用全关节镜下治疗跟腱部分撕裂的Haglund综合征的24例患者资料,依据手术方式不同分为关节镜下跟腱止点清理组（A组）和关节镜下跟腱止点清理+跟腱止点增强重建组（B组）,每组各12例。术后定期随访,采用疼痛视觉模拟（VAS）评分、美国足踝外科协会（AOFAS）足踝功能评分及维多利亚体育研究所评分（VISA-A）评估治疗结果,进行观察对比。结果 患者平均随访时间（7.5±0.8）个月,末次随访均不存在后足跟肿痛、跟腱再次断裂等并发症。所有患者症状较术前均得到缓解。A组和B组的VAS评分、AOFAS评分、VISA-A评分均较术前有所改善;然而A组和B组术前及术后6个月的VAS、AOFAS、VISA-A评分对比,差异无统计学意义（P>0.05）;B组术后1、3个月的VAS、AOFAS、VISA-A评分优于A组,差异有统计学意义（P<0.05）。结论 全关节镜下跟腱止点增强重建治疗跟腱部分撕裂的Haglund综合征,较关节...     

小腿有关肌腱转位修复跟腱的生物力学评价

目的：为临床选用自体肌腱转位修复跟腱提供生物力学依据。方法：选用防腐固定成年和新鲜青年下肢各７例。制备拉伸试件，在ＳＷＤ－１０型材料试验机上，进行单向拉伸破坏实验。结果：跟腱、腓骨长肌腱、腓骨短肌腱、胫骨后肌腱及展肌腱固定组分别为２２９２．６Ｎ、１０２０．５Ｎ、７５２．０Ｎ、９３８．９Ｎ和７２１．３Ｎ，新鲜组分别为１９２７．１Ｎ、８１９．５Ｎ、３４６．７Ｎ、６９９．７Ｎ、３０３．８Ｎ。结论：腓骨长肌腱是跟腱缺损修复术较理想的自体材料。     

The plantaris tendon and a potential role in mid-portion Achilles tendinopathy: an observational anatomical study

The source of pain and the background to the pain mechanisms associated with mid-portion Achilles tendinopathy have not yet been clarified. Intratendinous degenerative changes are most often addressed when present. However, it is questionable if degeneration of the tendon itself is the main cause of pain. Pain is often most prominent on the medial side, 2-7cm from the insertion onto the calcaneus. The medial location of the pain has been explained to be caused by enhanced stress on the calcaneal tendon due to hyperpronation. However, on this medial side the plantaris tendon is also located. It has been postulated that the plantaris tendon might play a role in these medially located symptoms. To our knowledge, the exact anatomy and relationship between the plantaris- and calcaneal tendon at the level of complaints have not been anatomically assessed. This was the purpose of our study. One-hundred and seven lower extremities were dissected. After opening the superficial fascia and paratendon, the plantaris tendon was bluntly released from the calcaneal tendon moving distally. The incidence of the plantaris tendon, its course, site of insertion and possible connections were documented. When with manual force the plantaris tendon could not be released, it was defined as a 'connection' with the calcaneal tendon. In all specimens a plantaris tendon was identified. Nine different sites of insertion were found, mostly medial and fan-shaped onto the calcaneus. In 11 specimens (10%) firm connections were found at the level of the calcaneal tendon mid-portion. Clinical and histological studies are needed to confirm the role of the plantaris tendon in mid-portion Achilles tendinopathy.     

带血管蒂肌腱移植修复跟腱缺损的实验研究

目的为带血供肌腱移植修复跟腱缺损提供生物力学和组织学依据.方法选用新西兰大白兔15只,其中12只分两组一侧行带血管蒂趾长屈肌腱转位修复跟腱缺损,对侧为游离肌腱移植对照组,术后12周取材,分别行组织学检查和生物力学测试.结果带血管蒂肌腱组移植跟腱组织学形态近似正常跟腱,肌腱最大拉伸力为正常跟腱的67.7%,而游离肌腱组移植跟腱的腱纤维为瘢痕包裹,最大拉伸力为跟腱的35.3%,两者的差异性非常显著(P＜0.01).结论带血管蒂肌腱移植修复跟腱缺损优于游离肌腱移植.     

The influence of aging on the insertion of the Achilles tendon: A magnetic resonance study

The aim of this study was to examine the variations of the Achilles tendon (AT) insertion point into the calcaneal bone (CB) in relation to age and sex using magnetic resonance imaging (MRI). A total of 202 foot and ankle MRIs were reviewed and patients were allocated into three age groups: (I) <18, (II) 18-65, and (III) >65 years. All measurements were obtained on a mid-sagittal scan. The mean measurement values were used to assess the relationships among the AT insertion point, sex, and age. Our main findings revealed that (1) the distance between the most inferior point of the CB and the most inferior part of the AT insertion into the CB increases with age, (2) the height of the AT insertion into the posterior aspect of the CB decreases with age, and (3) the length of the AT insertion into the posterior aspect of the CB decreases with age. The terminal insertion point of the AT on the CB in younger subjects was more distal, whereas in older individuals it was more proximal. These results could help in developing novel strategies for the treatment and prophylaxis of AT injuries in particular patient age groups. Anatomical data about the AT insertion are crucial for developing a computer model of the AT and for biomechanical considerations regarding this tendon. Clin. Anat. 33:545–551, 2020. © 2019 Wiley Periodicals, Inc.     

The twisted structure of the rat Achilles tendon

The rat is frequently used as a model to study the characteristics, aetiology and pathology of the Achilles tendon. However, though the structure of the human Achilles tendon has been extensively investigated, the anatomical structure of the rat Achilles tendon remains unclear, which impedes the ability to use rats to study Achilles tendinopathy. The purpose of this study was to reveal the structure of the rat Achilles tendon and to explore its similarities with the human Achilles tendon through an anatomical dissection of 80 rat Achilles tendons (40 female, 40 male). This study found that the subtendons of the rat Achilles tendon originating from the triceps surae muscle were twisted, and each subtendon also had its own torsion. The extent of these two types of torsion could be very different between rats. Alterations in this torsion may result in distinct stress fields in the Achilles tendon, which may play a critical role in the pathogenesis of Achilles tendinopathy. This study provides an important basis to support the use of rats as model animals to investigate the characteristics of the human Achilles tendon and Achilles tendinopathy.     

肿瘤坏死因子α拮抗剂对应力屏蔽导致的跟腱挛缩形态学影响

背景：跟腱应力屏蔽后肿瘤坏死因子α明显升高,应用肿瘤坏死因子α拮抗剂干预肿瘤坏死因子α的作用是否会干预跟腱挛缩尚不清楚。 目的：通过观察重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)干预应力屏蔽后大鼠跟腱形态学变化,了解肿瘤坏死因子α在肌腱挛缩中的影响及肿瘤坏死因子α拮抗剂对肌腱挛缩的干预作用。 方法：20只健康雄性SD大鼠左后肢行跟腱应力屏蔽后随机数字表法均分为实验组和模型组,两组中随机各抽取5只大鼠以右后肢为正常对照组。建模后即刻实验组大鼠使用0.6 mg/kg重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白、模型组使用1 mL磷酸缓冲盐溶液于大鼠皮下注射,后根据重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白半衰期两组分别再注射3次,干预2周时大体下及透射电镜下观察跟腱形态学改变。 结果与结论：大体观察实验组跟腱明显比模型组细小、光滑,但较正常对照组粗。电镜下模型组胶原纤维束较实验组组疏松、紊乱;实验组横切面和纵切面均与正常对照组差异无显著性意义。说明,在2周时,肿瘤坏死因子α拮抗剂能明显预防应力屏蔽所致的肌腱挛缩。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

The frequency of Achilles and plantar calcaneal spurs in gout patients

Background/aim Gout may cause various radiographic abnormalities such as cartilage loss, spurs, sclerosis, and periostal new bone formation. The purpose of this study was to investigate the frequency of Achilles and plantar spurs and related factors in gout patients.Matherial and methodsWe performed a retrospective review of gout patients, treated at Hacettepe University hospitals between 2014 and 2019. We identified patients from the hospital records using the ICD-10 code (M10). Demographic and clinical features, comorbidities, and foot radiographies were collected. The radiographies were evaluated by a rheumatologist (U.K.) who was experienced in musculoskeletal radiography. Factors predicting the spurs were analyzed by logistic regression analysis.Results181 patients who had lateral foot radiograph were included in this study. Eighty-one (44.7%) patients had score ≥ 2 Achilles spur, 81 (44.7%) patients had score ≥ 2 plantar spur, and 22 (12.1%) patients had no spur. Age, disease duration, duration between the gout diagnosis and appearing spur, the presence of metabolic comorbidities and hypertension were higher in both Achilles and plantar spurs than no spur group. Forty (22.1%) patients had score ≥ 2 both Achilles and plantar spur. In this group, the mean age was older and the proportion of metabolic comorbidities was higher than the groups of Achilles and plantar spur with a score 0 or 1. Predictor of the development of large or moderate-severe calcaneal spur was the existence of metabolic comorbidity [OR (95% CI): 3.49 (1.11–11.0) and p = 0.033].ConclusionThe presence of metabolic comorbidities increases the frequency of calcaneal spurs in gout patients. This condition can be explained by the impaired microvascular structure and increased hypoxia resulting in calcification on the tendon and ligament insertion sites.     

Enforced Bipedal Downhill Running Induces Achilles Tendinosis in Rats

Enforced downhill running has been reported to induce tendinosis in the rat supraspinatus tendon but similar exercise failed to induce Achilles tendinosis in this animal. Due to the presence of acromial arch in the shoulder, accessing the supraspinatus tendon with physical modalities is difficult; thus this model may not be suitable for studying the treatment for tendinosis. To develop a rat model for Achilles tendinosis, we tested 14 mature Sprague–Dawley rats by dividing them into 2 groups of 7 each. The experimental group was subjected to a daily enforced downhill bipedal running program by suspending their upper bodies so that they ran with their hind limbs on a treadmill for 1 hr/day for 8 weeks. The downward inclination was 20° and the speed was 17 m/min. The animals in the control group did not undergo any exercise. After 8 weeks, the Achilles tendons were harvested and subjected to histological and biomechanical analysis. Histological examination revealed tenocyte proliferation, change in tenocytes appearance, and collagen bundle disintegration in the running group. The biomechanical testing revealed significant decrease in stiffness (p?=?0.002) and ultimate tensile strength (p?=?0.016) in the running group than in the control group. Both the histological and biomechanical findings are suggestive of changes in the tendon of the running group that resembled the pathological changes of tendinosis in human. This new model of Achilles tendinosis in rat will be useful for studying the etiology and subsequent management strategies of this condition.     

跟腱断端瘢痕组织修复在陈旧性跟腱断裂治疗中的应用

目的 探讨修复跟腱断端瘢痕组织治疗陈旧性跟腱断裂的临床疗效。方法 横断面研究。纳入2018年8月—2021年7月中国科学技术大学附属第一医院收治的21例陈旧性跟腱断裂患者的临床资料。其中男17例,女4例;年龄20~73（43.5±16.0）岁;右侧11例,左侧10例;患者均采用修复跟腱断端瘢痕组织治疗陈旧性跟腱断裂。记录手术时间、切口长度、术后并发症,以及日常活动、运动恢复时间;比较术前与术后末次随访时美国足踝外科协会（AOFAS）的踝-后足评分、疼痛视觉模拟评分法（VAS）评分;记录末次随访时患者跟腱完全断裂评分（ATRS）、Arner-Lindholm评分、单足提踵试验结果。结果 本组患者手术时间30~50 min（平均41.1 min）,手术切口4~7 cm（平均5.6 cm）;术后无感染、腓肠神经损伤和再破裂等严重并发症出现。所有患者术后获6~40个月（平均18.5个月）的随访。患者术后恢复日常活动时间（4.4±0.7）个月、恢复运动时间（11.1±1.5）个月。AOFAS的踝-后足评分由术前（63.5±6.9）分提高至末次随访的（89.9±4.8）分,疼痛VAS评分由术前4（3,4）分降低至末次随访的0（0,1）,差异均有统计学意义（t=-14.45、Z=5.69,P值均<0.001）。末次随访时ATRS达（92.7±3.6）分;Amer-Lindholm评分评价优15例、良6例,优良率为100％;单足提踵试验阳性率9.52%（2/21）,单足提踵恢复时间4~7 （5.1±0.9）个月。结论 修复断端跟腱瘢痕组织治疗陈旧性跟腱断裂可以达到满意的临床疗效,且具有安全性高及并发症少等优点。     

Role of moderate exercising on Achilles tendon collagen crimping patterns and proteoglycans

Abstract

In this study, the morphological and morphometric changes in the collagen crimping pattern of Achilles tendon and metabolism/expression of tenocytes explanted from tendons of running (RUN) and sedentary (SED) rats were investigated to assess the effects of 12 weeks moderate running exercise. The number, the top angle width and the base length of each crimp in three different regions (proximal, central and distal) of RUN and SED tendons were measured with a polarized light microscope. The most significant morphometric differences in the crimps were detectable in the central region of the RUN tendons. In this region, crimps were fewer, larger and more flattened than those of other regions as a consequence of a functional adaptation of extracellular matrix to running, in order to increase tendon stiffness and force transmission efficiency. Conversely, the top angle width of the crimps reduced in proximal and distal regions of the RUN tendons, suggesting that these crimps might act as more reactive mechanical springs, able to store and improve the release of the stored strain energy in most loaded regions. Tenocytes explanted from Achilles tendons of both RUN and SED groups were cultured. Running influenced tenocytes which showed a significant increase in collagen type-I synthesis and proteoglycans production, suggesting enhancement of the loading transmission efficiency and facilitate inter-fibril and inter-fiber sliding.     

Microprocessor-based instrument for Achilles tendon reflex measurements

A microprocessor-based system for automatic measuring and evaluation of the reflex of the Achilles tendon is described. An optoelectric transducer for detecting foot movement was used. The electronic equipment enables the simultaneous measurement of three time intervals of the reflex curve calculated from the moment of stimulation. A microprocessor controls the measuring process, communicates with the operator, stores data to the memory, evaluates the results of several measurements and sorts the patient into one of the following groups: (i) reflex normal, (ii) reflex abnormal. The measurement of the time intervals of the Achilles tendon reflex represents an important diagnostic procedure in therapy of the thyroid gland.     

Anatomy of the Achilles tendon (tendo calcaneus) with respect to tendon thickness measurements

Summary 267 normal controls of different ages underwent achilles tendon thickness measurements by ultrasonography (US) for reference. 96 recruits and 10 young women additionally underwent magnetic resonance imaging of the achilles tendons and calves for more systematic evaluation of the factors influencing tendon thickness. Children under 10 had a tendon thickness (mean±SD) of 4.6±0.8 mm, 10–17 year-olds 6.1±0.8 mm, 18–30 year-olds 6.3±0.5 mm and over 30 year-olds 6.9±1.0 mm. Women had slightly thinner tendons than men, but the difference was statistically significant only in the oldest age group. Normal variation in shape of the tendon caused up to a 25% variation in the measured thickness values. In the large sample of recruits a statistically significant correlation was found between the tendon thickness and body height. Differences in population height could account for the measured differences in normal achilles tendon thickness found in studies on Japanese subjects compared with studies on European and American subjects.

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Anatomie du tendon calcanéen (tendon d'Achille) : mesures de l'épaisseur du tendon

Résumé L'épaisseur du tendon calcanéen de 267 sujets normaux d'âges différents a été mesurée par échographie. 96 recrues et 10 jeunes femmes ont en plus subi une imagerie par résonance magnétique des tendons calcanéens et des mollets pour une évaluation plus systématique des facteurs pouvant influencer l'épaisseur du tendon. L'épaisseur du tendon était de 4,6±0,8 mm chez les enfants de moins de 10 ans, de 6,1±0,8 mm chez les adolescents de 10 à 17 ans, de 6,3±0,5 mm chez les adultes de 18 à 30 ans, et de 6,9±1,0 mm chez ceux de plus de 30 ans. Les femmes avaient des tendons légèrement plus fins que les hommes, mais la différence n'etait pas statistiquement significative, sauf dans la tranche d'âge la plus élevée. Les variations normales de forme du tendon provoquaient des variations de plus de 25 % des valeurs de l'épaisseur tendineuse. Dans la population des recrues, une corrélation statistiquement significative existait entre l'épaisseur tendineuse et la taille. Des différences de taille dans la population étudiée peuvent expliquer les différences observées lors des mesures d'épaisseur de tendon calcanéen effectuées sur des sujets japonais d'une part, des sujets européens et américains d'autre part.

     

吻合血管大收肌腱复合组织瓣移植修复跟腱缺损的应用解剖

目的 :为吻合血管的大收肌腱复合组织瓣移植修复跟腱缺损新术式提供解剖学依据。方法 :在 40侧经动脉灌注红色乳胶成人尸体下肢标本上 ,对膝降动脉的起始、走行、分支和分布 ,以及大收肌腱的形态、血供等解剖观察。结果 :膝降动脉 95 %起于股动脉 ,起始处距收肌结节 7.8± 0 .8cm ,膝降动脉90 %发出隐支、股内侧肌支和关节支 ,膝降动脉和关节支起始外径分别为 :1.9± 0 .4mm和 1.4± 0 .4mm ,关节支伴大收肌腱下行 ,分支供养大收肌腱及股骨内侧髁。结论 :以膝降血管为蒂可形成大收肌腱骨皮复合组织瓣 ,吻合血管移植可修复不同类型的跟腱缺损 ,术式简便易行 ,供区损伤小。     

The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon

Achilles tendinopathy is a common degenerative condition without a definitive treatment. An adequate chronic animal model of Achilles tendinopathy has not yet been developed. The purpose of this study was to evaluate the individual and combined effects of dry needling and treadmill running on the Achilles tendon of rats. Percutaneous dry needling, designed to physically replicate microrupture of collagen fibers in overloaded tendons, was performed on the right Achilles tendon of 80 Sprague–Dawley rats. The rats were randomly divided into two groups: a treadmill group, which included rats that underwent daily uphill treadmill running (n?=?40), and a cage group, which included rats that could move freely within their cages (n?=?40). At the end of weeks 1 and 4, 20 rats from each group were sacrificed, and bilateral Achilles tendons were collected. The harvested tendons were subjected to mechanical testing and histological analysis. Dry needling induced histological and mechanical changes in the Achilles tendons at week 1, and the changes persisted at week 4. The needled Achilles tendons of the treadmill group tended to show more severe histological and mechanical changes than those of the cage group, although these differences were not statistically significant. Dry needling combined with free cage activity or treadmill running produced tendinopathy-like changes in rat Achilles tendons up to 4 weeks after injury. Dry needling is an easy procedure with a short induction period and a high success rate, suggesting it may have relevance in the design of an Achilles tendinopathy model.     

The age-related changes of trunk responses to Achilles tendon vibration

The contribution of different sensory modalities to balance control is modified by age. Postural responses to Achilles tendon vibration were investigated in order to understand the influence of age on proprioceptive input from lower legs in human stance. Postural responses to bilateral vibrations of Achilles tendon with 10 s duration were recorded at three frequencies (40, 60 and 80 Hz) in 9 healthy young (range, 24–27 years) and in 9 healthy older adults (59–70 years). Subjects were instructed to keep standing on firm surface with eyes closed. They performed three trials in each of three vibration frequencies. Postural responses were characterized by displacement of the centre of foot pressure (CoP) and by kinematics of body segments in the anterior–posterior direction. Bilateral vibrations of Achilles tendon induced backward body lean increasing with frequency of vibration and with age. The leg angle response to vibration was found similar in both groups of subjects. Slight trunk tilts from vertical position were induced by vibration in young subjects while in older subjects the trunk tilted backward together with the whole body. This observation was supported also by the minimal change of hip angle in older subjects contrary to increased hip activity in young subjects. The findings showed that the trunk and hip angle responses to proprioceptive stimulation might be a good indicator of age-related destabilization in balance control.     

Evidence for an elongated Achilles tendon in Australopithecus

Modern humans have the longest Achilles tendon (AT) of all the living primates. It has been proposed that this anatomy increases locomotor efficiency and that its elongation may have played a crucial role in the origin and early evolution of the genus Homo. Unfortunately, determining the length of the AT in extinct hominins has been difficult as tendons do not fossilize. Several methods have been proposed for estimating the length of the AT from calcaneal morphology, but the results have been inconclusive. This study tested the relationship between the area of the superior calcaneal facet and AT length in extant primates. The superior facet is instructive because it anchors the retrocalcaneal bursa, a soft tissue structure which helps to reduce friction between the AT and the calcaneus. Calcanei from 145 extant anthropoid primates from 12 genera were photographed in posterior view and the relative superior facet size quantified. AT lengths were obtained from published sources. The relative area of the superior facet is predictive of AT length in primates (R² = 0.83; p < .001) and differs significantly between the great apes and humans (p < 0.001). When applied to fossil Australopithecus calcanei, our results suggest that australopiths possessed a longer, more human-like, AT than previously thought. These findings have important implications for the locomotor capabilities of Australopithecus, including their capacity for endurance running and climbing.     

带腓肠肌肌腱的腓肠神经营养血管复合皮瓣修复跟腱并皮肤缺损

目的探讨带腓肠肌肌腱的腓肠神经营养血管复合皮瓣修复跟腱并皮肤缺损的效果。方法复合皮瓣修复跟腱并皮肤缺损6例,其中3例跟腱背侧部分缺损,2例跟腱内侧部分缺损,1例跟腱完全缺损。切取带腓肠肌肌腱的腓肠神经营养血管复合皮瓣时,保持肌腱与皮瓣深筋膜的联系。皮瓣大小7cm×5cm～11cm×10cm,腓肠肌肌腱大小为5cm×3cm～9cm×4cm。结果6例皮瓣均完全成活,感染控制;6例术后随访3～50个月,皮瓣外观满意,无跟腱再断裂者。患侧踝关节屈伸范围基本正常,功能评定,优5例,良1例。结论带腓肠肌肌腱的腓肠神经营养血管复合皮瓣修复跟腱并皮肤缺损具有手术操作简单,术后跟腱粘连轻,功能恢复好的优点。     

Age-related changes in biomechanical properties of the Achilles tendon in rabbits

We investigated age-related changes in the mechanical properties of rabbit Achilles tendon. The animals used were immature (age 3 weeks, body mass 380 g), young adult (age 8–10 months, body mass 4.1 kg) and old (age 4–5 years, body mass 5.1 kg) rabbits. The cross-sectional area of the tendon increased with growth and the tensile strength of the young adult [67.3 (SEM 4.2) MPa] and old [66.7 (SEM 3.8) MPa] tendon was significantly higher than that of the immature tendon [23.9 (SEM 3.8) MPa]. However, there was no statistically significant difference in tensile strength between mature and old tendons. These differences may be attributable to the change in body mass. The gradient of the stress-strain curves, that is, the tangent modulus of the mature tendon [618.0 (SEM 87.0) MPa], was higher than that of the immature [281.0 (SEM 104.6) MPa] and old [530.5 (SEM 91.0) MPa] tendon, although the difference was not significant. The elongation at failure was approximately 16% for all age groups. These results would suggest that rabbit Achilles tendon is highly compliant during growth.     

应用自制简易装置微创治疗跟腱断裂疗效分析

目的 评估应用自制简易装置微创治疗跟腱断裂的疗效.方法 对2016年1月至2018年6月期间收治的急性跟腱断裂患者共11例进行回顾性分析.利用自制的工具小切口修补跟腱断端,统计手术时间,切口长度,出血量,术后切口感染率、皮肤坏死率、术后腓肠神经损伤率、再断裂率,住院时间,记录术后6、12、18个月的AOFAS评分.结果...