Lawrence J E, Nasr P, Fountain D M, Berman L, Robinson A H N
Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK.
Bone Joint J. 2017 Jan;99-B(1):87-93. doi: 10.1302/0301-620X.99B1.BJJ-2016-0452.R1.
This prospective cohort study aims to determine if the size of the tendon gap following acute rupture of the Achilles tendon shows an association with the functional outcome following non-operative treatment.
All patients presenting within two weeks of an acute unilateral rupture of the Achilles tendon between July 2012 and July 2015 were considered for the study. In total, 38 patients (nine female, 29 male, mean age 52 years; 29 to 78) completed the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon Total Rupture score (ATRS) six months after the completion of a rehabilitation programme.
Patients with a gap ≥ 10 mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps < 10 mm (mean 23.3%; 7% to 52% vs 14.3%; 0% to 47%, p = 0.023). However, there was no difference in ATRS between the two groups (mean score 87.2; 74 to 100 vs 87.4; 68 to 97, p = 0.467). There was no significant correlation between gap size and torque deficit (τ = 0.103), suggesting a non-linear relationship. There was also no significant correlation between ATRS and peak torque deficit (τ = -0.305).
This is the first study to identify an association between tendon gap and functional outcome in acute rupture of the Achilles tendon. We have identified 10 mm as a gap size at which deficits in plantarflexion strength become significantly greater, however, the precise relationship between gap size and plantarflexion strength remains unclear. Large, multicentre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures. Cite this article: Bone Joint J 2017;99-B:87-93.
这项前瞻性队列研究旨在确定跟腱急性断裂后肌腱间隙的大小是否与非手术治疗后的功能结果相关。
2012年7月至2015年7月期间，所有在跟腱急性单侧断裂两周内就诊的患者均纳入本研究。共有38例患者（9例女性，29例男性，平均年龄52岁；年龄范围29至78岁）完成了研究。通过动态超声检查来确诊并测量断裂肌腱两端之间的间隙。在康复计划完成六个月后，采用背屈测力测试和跟腱完全断裂评分（ATRS）来评估结果。
踝关节处于中立位时间隙≥10mm的患者，其峰值扭矩 deficit 显著大于间隙<10mm的患者（平均23.3%；7%至52% 对比14.3%；0%至47%，p = 0.023）。然而，两组之间的ATRS没有差异（平均得分87.2；74至100 对比87.4；68至97，p = 0.467）。间隙大小与扭矩 deficit 之间没有显著相关性（τ = 0.103），表明存在非线性关系。ATRS与峰值扭矩 deficit 之间也没有显著相关性（τ = -0.305）。
这是第一项确定跟腱急性断裂时肌腱间隙与功能结果之间关联的研究。我们已确定10mm为间隙大小的一个界限，当间隙达到此值时，背屈力量 deficit 会显著增大，然而，间隙大小与背屈力量之间的确切关系仍不清楚。需要开展大型多中心研究来阐明这种关系，并确定在患者报告的结果测量中峰值扭矩 deficit 有所体现的人群亚组。引用本文：《骨与关节杂志》2017年；99 - B：87 - 93。
