Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery
Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery
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DOI：
10.1136/bjsports-2012-091399
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发表时间：
2014-10-01
影响因子：
18.4
通讯作者：
Forsgren, Sture
中科院分区：
文献类型：
--
作者：
Alfredson, Hakan;Spang, Christoph;Forsgren, Sture
背景双侧中部跟腱病/肌腱病并不罕见，通常进行双侧治疗。动物实验表明，在Achilles tendinosis. ObjectiveTo评估Achilles tendinopathy.Methods手术的结果，中央神经元的机制的潜在参与，这项观察性研究包括13例（7男6女，平均年龄53岁），长期（6-120个月）的慢性疼痛双侧中部Achilles tendinopathy。选择研究时最疼痛的一侧首先进行手术。治疗是在局部麻醉下，在肌腱腹侧部分外进行超声引导和多普勒引导的刮除手术。患者在术后第一天开始行走。进行了随访，主要结局是视觉模拟量表的疼痛。在另一部分的研究中，标本从跟腱和跖肌腱在3例双侧跟腱病examined.Results短期随访显示术后改善的非手术侧，以及在11 13例手术侧。37（平均）个月后的最终随访显示，这11例患者的双侧疼痛显著缓解，患者满意度显著提高。在13例患者中，有2例由于持续疼痛而在另一侧（最初未手术侧）进行手术。形态学上，它被发现有类似的形态学效果，和免疫组化模式的酶参与信号物质的生产，bilates.Conclusion单侧治疗与刮擦操作可以有好处contradelarsed;临床意义是，单侧手术可能是一个合乎逻辑的第一次治疗的情况下，双边跟腱病。
Background Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis.Objectives To evaluate the outcome of surgery for Achilles tendinopathy.Methods This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6-120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined.Results Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally.Conclusion Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.