Böhm E, Thiel A, Czieske S
Institut für Pathologie der Krankenhäuser des Märkischen Kreises GmbH, Lüdenscheid.
Sportverletz Sportschaden. 1990 Mar;4(1):22-8. doi: 10.1055/s-2007-993593.
From 1. October 1985 to 31. December 1987 93 patients (82 male, 11 female) with rupture of the achillestendon were investigated by means of a questionnaire, the specimens obtained at operation were examined histologically. In two cases the operation was for a rerupture of the tendon, 7 and 8 weeks respectively after the first operation. In 6 cases a rupture followed a so-called incomplete rupture on the same side. 9 patients had had a tendonrupture of the other side between 2.5 and 10 years previously. 85.4% of the ruptures took place during a sporting activity. Of the 93 patients 55 (59%) regularly took part in long term sporting activities. Symptoms in the area of one or both achilles tendons were experienced by 32% of the patients. 80 patients with an achilles tendon rupture who were operated within 10 days demonstrated structural degeneration of at least moderate proportions, mostly severe or very severe (there was no relationship between the degree of degeneration and the age of the rupture). The signs of repair were consistent with the age of the rupture. In 56% of the ruptures up to four days old the repair process was considerably more advanced than the age of the rupture would suggest. 6 of 10 patients with the so-called "Archillodynie" demonstrated minor changes although 3 had more severe degenerative changes. Our inquiry clearly demonstrates that structural changes in the tendon took place before the injury. In the cases of achilles tendon rupture the processes of repair are an-adequate to compensate for the degenerative changes. The etiology of the structural degenerations is dependent on many endogenous and exogenous factors particularly the inadequacy of the repair processes.
1985年10月1日至1987年12月31日期间，对93例跟腱断裂患者（82例男性，11例女性）进行了问卷调查，并对手术获取的标本进行了组织学检查。其中2例为肌腱再断裂，分别在首次手术后7周和8周。6例为同一侧所谓不完全断裂后发生的断裂。9例患者另一侧肌腱在2.5至10年前曾发生断裂。85.4%的断裂发生在体育活动期间。93例患者中，55例（59%）经常参加长期体育活动。32%的患者一侧或双侧跟腱区域出现症状。80例在10天内接受手术的跟腱断裂患者显示出至少中度比例的结构退变，大多为重度或极重度（退变程度与断裂年龄之间无关联）。修复迹象与断裂年龄相符。在56%的4天内的断裂中，修复过程比断裂年龄所显示的更为先进。10例所谓“跟腱痛”患者中有6例显示轻微改变，尽管3例有更严重的退行性改变。我们的调查清楚地表明，肌腱的结构变化在损伤之前就已发生。在跟腱断裂的病例中，修复过程足以补偿退行性改变。结构退变的病因取决于许多内源性和外源性因素，特别是修复过程的不足。
