Treatment of midportion Achilles tendinosis:: similar clinical results with US and CD-guided surgery outside the tendon and sclerosing polidocanol injections
Treatment of midportion Achilles tendinosis:: similar clinical results with US and CD-guided surgery outside the tendon and sclerosing polidocanol injections
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DOI：
10.1007/s00167-007-0415-8
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发表时间：
2007-12-01
影响因子：
3.8
通讯作者：
Lorentzon, Ronny
中科院分区：
文献类型：
--
作者：
Alfredson, Hakan;Ohberg, Lars;Lorentzon, Ronny
先前已证明，针对肌腱腹侧血管/神经向内生长的区域进行硬化性聚多卡醇注射，对于患有慢性疼痛性中部跟腱病的患者具有良好的临床效果。在这项研究中，连续 20 名患有慢性疼痛性中段跟腱病的患者（9 名男性和 11 名女性，平均年龄 46 岁）接受了硬化性聚多卡醇注射（A 组）或对跟腱腹侧血管/神经内生长区域（B 组）进行开放性手术修复。治疗前，所有患者均出现结构性肌腱变化和血流增加——超声和彩色多普勒显示新生血管形成。在超声和彩色多普勒引导下，注射和手术修复都针对肌腱腹侧部分外侧的新生血管区域。最多进行两次硬化注射治疗，间隔 6-8 周。为了进行评估，患者在治疗前后在VAS上记录了肌腱负荷活动（娱乐或体育活动）期间跟腱疼痛的严重程度。还评估了患者对治疗的整体满意度。 3个月随访时，A组有6/9（排除1名患者）和B组8/10患者对治疗感到满意，肌腱疼痛水平显着减轻（A组VAS为76至24，P < 0.05，B组VAS为75至21，P < 0.05）。 B组有1例深部感染。随访6个月时，A组6/9患者满意，B组10/10患者满意。总之，硬化性聚多卡醇注射治疗和腹侧跟腱中部外的开放性手术翻修治疗均显示出有希望的短期临床结果。
Sclerosing polidocanol injections targeting the area with vasculo/neural ingrowth on the ventral side of the tendon have previously been demonstrated to give good clinical results in patients with chronic painful midportion Achilles tendinosis. In this study, 20 consecutive patients (9 men and 11 women, mean age 46 years) with chronic painful midportion Achilles tendinosis were treated with either sclerosing polidocanol injections (Group A) or open surgical revision of the area with vasculo/neural ingrowth on the ventral side of the Achilles tendon (Group B). Before treatment, all patients had structural tendon changes and increased blood flow-neovascularisation demonstrated with US and colour Doppler. Under US and colour Doppler-guidance, both the injections and the surgical revision targeted the area with neovessels just outside the ventral part of the tendon. A maximum of two sclerosing injection treatments, with 6-8 weeks in-between, were given. For evaluation, the patients recorded the severity of Achilles tendon pain during tendon loading activity (their recreational or sport activity), before and after treatment, on a VAS. Patient global satisfaction with treatment was also assessed. At the 3 months follow-up 6/9 (one patient was excluded) patients in Group A, and 8/10 patients in Group B, were satisfied with the treatment and had a significantly reduced level of tendon pain (Group A VAS from 76 to 24, P < 0.05, Group B VAS from 75 to 21, P < 0.05). There was one deep infection in Group B. At the 6 months follow-up, 6/9 patients in Group A, and 10/10 patients in Group B were satisfied. In summary, both treatment with sclerosing polidocanol injections and open surgical revision outside the ventral Achilles midportion show promising short-term clinical results.