Alfredson Håkan, Spang Christoph
Department of Community Medicine and Rehabilitation, Sports Medicine Unit, Umeå University, S-901 87 Umeå, Sweden; ISEH, UCLH, London, UK; Pure Sports Medicine Clinic, London, UK.
Department of Integrative Medical Biology, Anatomy Section, Umeå University, S-901 87 Umeå, Sweden; Dr Alfen, Orthopedic Spine Center, 97080 Würzburg, Germany.
Foot Ankle Surg. 2018 Dec;24(6):490-494. doi: 10.1016/j.fas.2017.05.011. Epub 2017 Jun 12.
Non-invasive treatment is not always successful in patients with Achilles tendon disorders, and surgical treatment is instituted as the next step. There is sparse knowledge about the diagnoses, pain levels before surgery, surgically confirmed pathologies and postoperative complications in large patient groups.
To study the diagnoses, pain scores before surgery, macroscopic surgical findings and postoperative complications in a series of patients treated for Achilles disorders.
One surgeon operated on 771 Achilles tendons of 481 men and 290 women during a 10-year period. The clinically and ultrasound confirmed diagnoses, pre-operative pain and functional scores (Visual Analogue Scale, VAS, range 0-100; Victorian Institute Sports Tendon Assessment - Achilles questionnaire, VISA-A), macroscopic findings during surgery and postoperative complications, were retrospectively collected from a database.
Clinically, by ultrasound and during surgery midportion Achilles tendinopathy was confirmed in 519 (67%) patients, 41% of them had a thickened plantaris tendon located close the Achilles tendon. Partial midportion rupture was found in 31 (4%) patients, chronic midportion rupture in 12 (2%) patients and insertional Achilles tendinopathy, including superficial and retro-calcaneal bursitis, Haglund deformity, distal Achilles tendinopathy, plantaris tendon pathology, and bone spurs, in 209 (27%) patients. The mean pre-operative pain scores for midportion Achilles tendinopathy were 73 (VAS) and 45 (VISA-A), and for insertional Achilles tendinopathy 77 (VAS) and 39 (VISA-A). For midportion Achilles tendinopathy there were 14 (3%), and for insertional Achilles tendinopathy 10 (5%), postoperative complications.
Patients presenting high pain scores from midportion Achilles tendinopathy were the most common. Plantaris tendon involvement is a frequent observation. For insertional Achilles tendinopathy the combination of pathology in the subcutaneous and retrocalcaneal bursa, a Haglund deformity and distal Achilles tendinopathy/tendinosis was most frequent.
SERIES STUDY, LEVEL OF EVIDENCE: 4.
跟腱疾病患者的非侵入性治疗并非总是成功，下一步会采取手术治疗。对于大型患者群体的诊断、手术前疼痛程度、手术确诊的病理情况及术后并发症，人们了解甚少。
研究一系列接受跟腱疾病治疗患者的诊断、手术前疼痛评分、宏观手术发现及术后并发症。
在10年期间，一名外科医生对481名男性和290名女性的771条跟腱进行了手术。从数据库中回顾性收集临床及超声确诊的诊断、术前疼痛和功能评分（视觉模拟量表，VAS，范围0 - 100；维多利亚运动肌腱评估 - 跟腱问卷，VISA - A）、手术中的宏观发现及术后并发症。
临床、超声及手术中确诊519例（67%）患者为跟腱中部肌腱病，其中41%患者的跖肌腱增厚且靠近跟腱。发现31例（4%）患者为跟腱中部部分断裂，12例（2%）患者为跟腱中部慢性断裂，209例（27%）患者为跟腱附着点肌腱病，包括皮下和跟腱后滑囊炎、Haglund畸形、跟腱远端肌腱病、跖肌腱病变及骨赘。跟腱中部肌腱病的术前平均疼痛评分为VAS 73分、VISA - A 45分，跟腱附着点肌腱病为VAS 77分、VISA - A 39分。跟腱中部肌腱病术后并发症有14例（3%），跟腱附着点肌腱病有10例（5%）。
跟腱中部肌腱病疼痛评分高的患者最为常见。跖肌腱受累情况常见。跟腱附着点肌腱病中，皮下和跟腱后滑囊病变、Haglund畸形及跟腱远端肌腱病/肌腱变性的组合最为常见。
系列研究，证据级别：4级。
