Knobloch Karsten, Kraemer Robert, Lichtenberg Artur, Jagodzinski Michael, Gossling Thomas, Richter Martinus, Zeichen Johannes, Hufner Tobias, Krettek Christian
Trauma Surgery, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Am J Sports Med. 2006 Jan;34(1):92-7. doi: 10.1177/0363546505278705. Epub 2005 Oct 11.
Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial.
To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy.
Cohort study; Level of evidence, 2.
In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 +/- 8 years), 14 patients had insertional pain (7 men, 29 +/- 8 years), and 11 patients had midportion tendinopathy (7 men, 38 +/- 13 years, not significant).
Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 +/- 79 vs 132 +/- 42, P < .05) as well as in midportion tendinopathy (150 +/- 74 vs 119 +/- 34, P < .05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 +/- 42 insertional asymptomatic vs 119 +/- 34 mid-portion vs 120 +/- 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different.
Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.
在跟腱病中，可通过能量多普勒定性检测新生血管形成。关于肌腱微循环的定量数据尚未确立，但其可能相当可观。
评估健康志愿者以及患有中部或附着点跟腱病的运动员的跟腱和腱旁组织的微循环情况。
队列研究；证据等级，2级。
对66名身体活跃的志愿者，在静息状态下于2毫米和8毫米组织深度测定跟腱和腱旁组织微循环参数，如组织氧饱和度、毛细血管后静脉相对充盈压和微循环血流量。41名患者从未有过跟腱疼痛（25名男性，年龄27±8岁），14名患者有附着点疼痛（7名男性，年龄29±8岁），11名患者有中部跟腱病（7名男性，年龄38±13岁，差异无统计学意义）。
有症状的肌腱在距附着点2厘米和6厘米处的跟腱直径增加。与对侧未受累肌腱相比，附着点处（160±79对132±42，P<.05）以及中部跟腱病处（150±74对119±34，P<.05）的深部微循环血流量显著升高。未受累对侧肌腱和正常运动员对照组的微循环无显著差异（附着点无症状组132±42对中部11±34对健康肌腱120±48）。所有组的附着点腱旁深部微循环血流量均升高，而组织氧饱和度和毛细血管后静脉相对充盈压无显著差异。
在附着点和中部跟腱病的疼痛部位，微循环血流量显著升高。在跟腱中部和腱旁中部，毛细血管后静脉充盈压升高，而各研究组之间的组织氧饱和度无差异。我们未发现跟腱病无症状肢体存在异常微循环的证据。
