Klos Kajetan, Gueorguiev Boyko, Carow John Bennet, Modabber Ali, Nebelung Sven, Kim Bong-Sung, Horst Klemens, Weber Christian David, Knobe Matthias
Department of Foot and Ankle Surgery, Catholic Hospital Mainz, Mainz, Germany.
AO Research Institute Davos, Davos, Switzerland.
J Orthop Surg Res. 2018 Jun 7;13(1):142. doi: 10.1186/s13018-018-0850-x.
Dorsal approaches to the hindfoot are frequently used. Furthermore, the vascular supply is discussed as a possible cause for ruptures and degeneration of the Achilles tendon. The aim of this study was to evaluate the microperfusion of three possible posterior approaches to the hindfoot and different areas of the Achilles tendon.
In 111 subjects, a laser Doppler/white light spectroscopy was used to measure microperfusion in terms of blood flow (Flow) and capillary venous oxygen saturation (SO2) in the hindfoot and Achilles tendon. Measurements were performed at two measurement points (MP, proximal and distal) of three dorsal approaches (medial, lateral and central) and inside the Achilles tendon.
Microperfusion differed partially between the surgical approaches. The medial and the lateral approaches were significantly superior to the central approach with regard to Flow in both MP (p < 0.001), while SO2 was significantly higher at the proximal measurement point (MP 1; p < 0.001). In this area, the lateral approach was significantly superior to the medial approach regarding Flow (MP 1; p = 0.012). The Achilles tendon exhibited a significantly reduced microperfusion 5 cm proximal to the calcaneal tubercle (SO2 p = 0.001; Flow p = 0.048). Demographic factors, such as body mass index and age, had different effects. Microcirculation was partially superior in men and negatively affected by smoking.
Soft tissue microcirculation on the lateral and medial side of the healthy Achilles tendon was better than centrally on the tendon. Proximally, the lateral approach was better than the medial approach. These circumstances could provide advantages regarding the surgical approach. The Achilles tendon exhibited significantly reduced microperfusion at the typical side of degeneration and rupture. This circumstance could be a possible cause of degenerative processes.
后足的背侧入路经常被使用。此外，血管供应被认为是跟腱断裂和退变的一个可能原因。本研究的目的是评估后足三种可能的后侧入路以及跟腱不同区域的微血管灌注情况。
在111名受试者中，使用激光多普勒/白光光谱仪测量后足和跟腱的血流（Flow）和毛细血管静脉血氧饱和度（SO2）来评估微血管灌注。在三种背侧入路（内侧、外侧和中央）的两个测量点（近端和远端测量点，MP）以及跟腱内部进行测量。
手术入路之间的微血管灌注存在部分差异。在内侧和外侧入路的两个测量点，血流（Flow）方面均显著优于中央入路（p < 0.001），而在近端测量点（MP 1），血氧饱和度（SO2）显著更高（p < 0.001）。在该区域，外侧入路在血流（Flow）方面显著优于内侧入路（MP 1；p = 0.012）。跟腱在跟骨结节近端5厘米处微血管灌注显著降低（SO2 p = 0.001；Flow p = 0.048）。人口统计学因素，如体重指数和年龄，有不同影响。男性的微循环部分更优，吸烟对其有负面影响。
健康跟腱内侧和外侧的软组织微循环优于肌腱中央部位。在近端，外侧入路优于内侧入路。这些情况可能为手术入路提供优势。跟腱在退变和断裂的典型部位微血管灌注显著降低。这种情况可能是退变过程的一个可能原因。
