Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Orthopedics, Danderyd Hospital, Stockholm, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2021-2029. doi: 10.1007/s00167-017-4621-8. Epub 2017 Jul 1.
Adjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing.
One hundred and fifty patients with surgical repair of acute ATR were post-operatively leg immobilized and prospectively randomized. Patients were allocated for 2 weeks of either adjuvant IPC treatment (n = 74) or treatment-as-usual (n = 74) in a plaster cast without IPC. The IPC group received 6 h daily bilateral calf IPC applied under an orthosis on the injured side. At 2 weeks post-operatively, tendon healing was assessed using microdialysis followed by enzymatic quantification of tendon callus production, procollagen type I (PINP) and type III (PIIINP) N-terminal propeptide, and total protein content. 14 IPC and 19 cast patients (control group) consented to undergo microdialysis. During weeks 3-6, all subjects were leg-immobilized in an orthosis without IPC. At 3 and 12 months, patient-reported outcome was assessed using reliable questionnaires (ATRS and EQ-5D). At 12 months, functional outcome was measured using the validated heel-rise test.
At 2 weeks post-rupture, the IPC-treated patients exhibited 69% higher levels of PINP in the ruptured Achilles tendon (AT) compared to the control group (p = 0.001). Interestingly, the IPC-treated contralateral, intact AT also demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002). There were no adverse events observed associated with IPC. At 3 and 12 months, no significant (n.s.) differences between the two treatments were observed using patient-reported and functional outcome measures.
Adjuvant IPC during limb immobilization in patients with ATR seems to effectively enhance the early healing response by upregulation of collagen type I synthesis, without any adverse effects. Whether prolonged IPC application during the whole immobilization period can also lead to improved long-term clinical healing response should be further investigated. The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which additionally prevents deep venous thrombosis.
Randomized controlled trial, Level I.
在跟腱断裂（ATR）后进行腿部固定时，辅助间歇性气动压缩（IPC）已被证明可以降低深静脉血栓形成的风险。本研究的目的是探讨 IPC 是否也能促进跟腱愈合。
150 例接受急性 ATR 手术修复的患者术后行腿部固定，并前瞻性随机分组。患者在石膏中接受 2 周的辅助 IPC 治疗（n=74）或常规治疗（n=74）。IPC 组在受伤侧矫形器下每天接受 6 小时双侧小腿 IPC。术后 2 周，采用微透析法评估跟腱愈合情况，随后用酶法定量分析跟腱骨痂生成、前胶原 I（PINP）和 III 型（PIIINP）N 端前肽、总蛋白含量。14 名 IPC 患者和 19 名石膏组患者（对照组）同意接受微透析。在第 3-6 周，所有患者均在无 IPC 的矫形器中进行腿部固定。在 3 个月和 12 个月时，使用可靠的问卷（ATRS 和 EQ-5D）评估患者报告的结局。在 12 个月时，使用经验证的足跟抬高试验测量功能结局。
在 ATR 后 2 周，IPC 治疗组患者的破裂跟腱中 PINP 水平比对照组高 69%（p=0.001）。有趣的是，IPC 治疗组对侧完整的跟腱中 PINP 浓度也比石膏组未治疗的完整跟腱高 49%（p=0.002）。IPC 治疗过程中未观察到任何不良反应。在 3 个月和 12 个月时，使用患者报告和功能结局测量方法，两种治疗方法之间没有显著差异（n.s.）。
在 ATR 患者的肢体固定中，辅助 IPC 似乎可以通过上调 I 型胶原合成，有效地增强早期愈合反应，而没有任何不良影响。在整个固定期间延长 IPC 应用是否也能导致改善长期临床愈合反应，应进一步研究。在跟腱断裂患者的腿部固定过程中，通过辅助 IPC 治疗可以改善愈合过程，同时还可以预防深静脉血栓形成。
随机对照试验，I 级。
