Enwemeka C S, Spielholz N I, Nelson A J
Department of Physical Therapy, University of Texas Health Science Center, San Antonio 78284.
Am J Phys Med Rehabil. 1988 Dec;67(6):264-9.
Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, atrophy and ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. Because these complications may be minimized by limited immobilization and early functional activities, we studied the effects of early weight bearing on the maximum breaking strength of tenotomized tendons in 30 Wistar rats. After tenotomy, the right hind limb of the first group of 10 rats was immobilized for the first 5 days. Thereafter their casts were removed to permit weight bearing for the next 3 days. In a second group of 10 rats, casts were removed 2 days after surgery, the animals were allowed 3 days of unrestricted use of the limb, and then the limbs were re-casted for another 3 days. In a third group of 10 rats the right hind limbs were casted throughout the first 8 days of healing. At the end of this time, strain gauge measurements showed that tendons in the second group healed significantly stronger and without rerupture than those in either of the two groups. Although healing time in rats does not directly translate to humans, our findings suggest that function may return faster in humans, as, for example, following Achilles tendon rupture, if a better combination of immobilization and activity could be found than is currently employed.
肌肉萎缩、关节僵硬、骨关节炎、感染、皮肤坏死、关节软骨萎缩和溃疡以及腱皮粘连是手术修复肌腱断裂后长期固定所产生的常见并发症。由于通过有限固定和早期功能活动可将这些并发症降至最低，我们研究了早期负重对30只Wistar大鼠离断肌腱最大断裂强度的影响。离断术后，第一组10只大鼠的右后肢在前5天进行固定。此后去除石膏，使其在接下来的3天内负重。在第二组10只大鼠中，术后2天去除石膏，让动物自由使用该肢体3天，然后再将肢体重新固定3天。在第三组10只大鼠中，右后肢在愈合的前8天一直进行固定。在此时间结束时，应变仪测量显示，第二组的肌腱愈合明显更强，且未再次断裂，优于其他两组。尽管大鼠的愈合时间不能直接类推到人类，但我们的研究结果表明，如果能找到比目前所用方法更好的固定与活动组合，那么在人类中，比如跟腱断裂后，功能恢复可能会更快。
