Early E-modulus of healing Achilles tendons correlates with late function: Similar results with or without surgery
Early E-modulus of healing Achilles tendons correlates with late function: Similar results with or without surgery
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DOI：
10.1111/j.1600-0838.2010.01154.x
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发表时间：
2012-02-01
影响因子：
4.1
通讯作者：
Aspenberg, P.
中科院分区：
文献类型：
--
作者：
Schepull, T.;Kvist, J.;Aspenberg, P.
跟腱断裂的非手术治疗与再断裂的风险增加有关。我们假设这是由于愈合早期的机械性能较差，并进行了一项随机试验，使用一种新的方法来测量机械性能。在损伤后3、7、19周和18个月，在肌腱残端插入钽标记物，并通过立体X线摄影（伦琴立体摄影分析）测量不同载荷下的肌腱应变。30例患者随机接受手术或非手术治疗。主要结果变量是7周时弹性模量的估计值。还测量了单位力应变、横截面积和肌腱伸长率。功能结局变量为18个月后的足跟抬高指数。在任何时间点，手术和非手术治疗之间的平均弹性模量或其他机械或功能变量均无差异，但非手术组在7周和19周时的应变/力变化显著更大。因此，该组可能包含更多愈合不良的离群值。在两个治疗组中，7周时的弹性模量与18个月后的足跟抬高指数相关（r2=0.75; P=0.0001）。这种相关性是一个有趣的发现。
Non-operative treatment of Achilles tendon ruptures is associated with an increased risk of rerupture. We hypothesized that this is due to inferior mechanical properties during an early phase of healing, and performed a randomized trial, using a new method to measure the mechanical properties. Tantalum markers were inserted in the tendon stumps, and tendon strain at different loadings was measured by stereo-radiography (Roentgen stereophotogrammetric analysis) at 3, 7 and 19 weeks and 18 months after injury. Thirty patients were randomized to operative or non-operative treatment. The primary out-come variable was an estimate for the modulus of elasticity at 7 weeks. Strain per force, cross-sectional area and tendon elongation were also measured. The functional outcome variable was the heel-raise index after 18 months. There was no difference in the mean modulus of elasticity or other mechanical or functional variables between operative and non-operative treatments at any time-point, but strain per force at 7 and 19 weeks had a significantly larger variation in the non-operative group. This group, therefore, might contain more outliers with poor healing. The modulus of elasticity at 7 weeks correlated with the heel-raise index after 18 months in both treatment groups (r2=0.75; P=0.0001). This correlation is an intriguing finding.