Guney A, Vatansever F, Karaman I, Kafadar I H, Oner M, Turk C Y
Department of Orthopaedics and Traumatology, Erciyes University Medical Faculty, Kayseri; Turkey.
Department of Orthopaedics and Traumatology, Training and Research Hospital, Kayseri; Turkey.
Exp Clin Endocrinol Diabetes. 2015 Jul;123(7):428-32. doi: 10.1055/s-0035-1549889. Epub 2015 Apr 28.
BACKGROUND/OBJECTIVES: Structural and functional impairments of the Achilles tendon in diabetic patients has the potential to contribute to ulcer formation through altered foot mechanics. This study aimed to examine the biomechanical and histopathological alterations in Achilles tendon specimens from diabetic vs. non-diabetic individuals.
42 Achilles tendon samples obtained from patients treated with below-knee or above-knee amputation for chronic diabetic foot ulcers (n=21) or for non-diabetic conditions (n=21) were included. A tensile test was performed for each tendon and a stress vs. strain graft was obtained to calculate following biomechanical parameters: elasticity (Young modulus), load, stiffness, toughness, energy, strain, elongation and tenacity. Groups were also compared with regard to histopathological findings (inflammatory cell infiltration, collagen organization, and degeneration).
Non-diabetic tendons exhibited a superior biomechanical profile over diabetic tendons with regard to the following biochemical parameters: elasticity, maximum load, stiffness, toughness, load, energy, strain and elongation at break point, tenacity, and strain at automatic load drop (p<0.05 for all comparisons). Diabetic tendons had mild impairment of collagen organization and focal collagen degeneration, whereas neither diabetic nor non-diabetic tendons had inflammatory cell infiltration.
The structural and functional alterations associated with diabetes adversely affect the biomechanical properties of the Achilles tendon, potentially acting together with neuropathy and ischemia in the development of diabetic foot ulcers.
背景/目的：糖尿病患者跟腱的结构和功能损伤有可能通过改变足部力学导致溃疡形成。本研究旨在检查糖尿病患者与非糖尿病患者跟腱标本的生物力学和组织病理学改变。
纳入42例跟腱样本，这些样本取自因慢性糖尿病足溃疡（n = 21）或非糖尿病疾病（n = 21）接受膝下或膝上截肢治疗的患者。对每条肌腱进行拉伸试验，并获得应力-应变曲线以计算以下生物力学参数：弹性（杨氏模量）、负荷、刚度、韧性、能量、应变、伸长率和强度。还比较了两组的组织病理学结果（炎症细胞浸润、胶原组织和变性）。
在以下生物化学参数方面，非糖尿病肌腱的生物力学特征优于糖尿病肌腱：弹性、最大负荷、刚度、韧性、负荷、能量、应变和断裂点伸长率、强度以及自动负荷下降时的应变（所有比较p<0.05）。糖尿病肌腱有轻度胶原组织损伤和局灶性胶原变性，而糖尿病和非糖尿病肌腱均无炎症细胞浸润。
与糖尿病相关的结构和功能改变对跟腱的生物力学特性有不利影响，可能在糖尿病足溃疡的发生发展中与神经病变和缺血共同起作用。
