跟腱断裂后跟腱长度、小腿肌肉萎缩和力量缺陷：先前研究中患者的长期随访。
Tendon Length, Calf Muscle Atrophy, and Strength Deficit After Acute Achilles Tendon Rupture: Long-Term Follow-up of Patients in a Previous Study.
机构信息
1Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., J.P., T.F., P.O., A.P., and J.L.), Department of Physical Medicine and Rehabilitation (P.S. and V.L.), and Department of Diagnostic Radiology, Institute of Diagnostics (J.N.), Oulu University Hospital, Medical Research Center, University of Oulu, Oulu, Finland.
出版信息
J Bone Joint Surg Am. 2017 Sep 20;99(18):1509-1515. doi: 10.2106/JBJS.16.01491.
BACKGROUND
In this prospective study, we used magnetic resonance imaging (MRI) to assess long-term Achilles tendon length, calf muscle volume, and muscle fatty degeneration after surgery for acute Achilles tendon rupture.
METHODS
From 1998 to 2001, 60 patients at our center underwent surgery for acute Achilles tendon rupture followed by early functional postoperative rehabilitation. Fifty-five patients were reexamined after a minimum duration of follow-up of 13 years (mean, 14 years), and 52 of them were included in the present study. Outcome measures included Achilles tendon length, calf muscle volume, and fatty degeneration measured with MRI of both the affected and the uninjured leg. The isokinetic plantar flexion strength of both calves was measured and was correlated with the structural findings.
RESULTS
The Achilles tendon was, on average, 12 mm (95% confidence interval [CI] = 8.6 to 15.6 mm; p < 0.001) longer (6% longer) in the affected leg than in the uninjured leg. The mean volumes of the soleus and medial and lateral gastrocnemius muscles were 63 cm (13%; p < 0.001), 30 cm (13%; p < 0.001), and 16 cm (11%; p < 0.001) lower in the affected leg than in the uninjured leg, whereas the mean volume of the flexor hallucis longus (FHL) was 5 cm (5%; p = 0.002) greater in the affected leg, indicating FHL compensatory hypertrophy. The median plantar flexion strength for the whole range of motion ranged from 12% to 18% less than that on the uninjured side. Finally, the side-to-side difference in Achilles tendon length correlated substantially with the strength deficit (ρ = 0.51, p < 0.001) and with medial gastrocnemius (ρ = 0.46, p = 0.001) and soleus (ρ = 0.42, p = 0.002) muscle atrophy.
CONCLUSIONS
Increased Achilles tendon length is associated with smaller calf muscle volumes and persistent plantar flexion strength deficits after surgical repair of Achilles tendon rupture. Strength deficits and muscle volume deficits are partly compensated for by FHL hypertrophy, but 11% to 13% deficits in soleus and gastrocnemius muscle volumes and 12% to 18% deficits in plantar flexion strength persist even after long-term follow-up.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景
在这项前瞻性研究中，我们使用磁共振成像（MRI）来评估急性跟腱断裂手术后跟腱的长期长度、小腿肌肉体积和肌肉脂肪变性。
方法
1998 年至 2001 年，我们中心的 60 名患者接受了急性跟腱断裂手术，并随后进行早期功能术后康复。55 名患者在至少 13 年（平均 14 年）的随访后再次接受检查，其中 52 名患者纳入本研究。评估指标包括 MRI 测量的患侧和健侧跟腱长度、小腿肌肉体积和脂肪变性。测量双侧小腿等速跖屈肌力，并与结构发现相关。
结果
跟腱平均长 12mm（95%置信区间[CI] = 8.6 至 15.6mm；p < 0.001），患侧比健侧长 6%。患侧比健侧的比目鱼肌、内侧和外侧三头肌体积分别低 63cm（13%；p < 0.001）、30cm（13%；p < 0.001）和 16cm（11%；p < 0.001），而患侧的长屈肌体积高 5cm（5%；p = 0.002），表明长屈肌发生了代偿性肥大。整个运动范围的跖屈强度中位数比健侧低 12%至 18%。最后，跟腱长度的侧-侧差异与力量缺陷（ρ=0.51，p < 0.001）以及内侧三头肌（ρ=0.46，p=0.001）和比目鱼肌（ρ=0.42，p=0.002）肌肉萎缩显著相关。
结论
跟腱延长与手术修复跟腱断裂后小腿肌肉体积减小和持续跖屈力量缺陷有关。长屈肌的代偿性肥大部分弥补了力量和肌肉体积的缺陷，但即使在长期随访后，比目鱼肌和三头肌仍有 11%至 13%的体积缺陷和 12%至 18%的跖屈力量缺陷。
证据等级
治疗学 2 级。请参阅作者指南以获取完整的证据等级描述。
Zotero 插件