Canavese Federico, Barbetta Davide, Canavese Bartolomeo, Dimeglio Alain
Department of Pediatric Surgery, University Hospital Estaing, Clermont-Ferrand, France.
Department of Life Sciences, University of Trieste, Trieste, Italy.
Indian J Orthop. 2019 Mar-Apr;53(2):333-339. doi: 10.4103/ortho.IJOrtho_397_17.
This study aimed to describe the clinical, radiological, biomechanical, electromyographic, and histoenzymologic modifications in the "Gastrocnemius-Achilles Tendon-Calcaneus complex" caused by percutaneous Achilles tendon lengthening (PATL) versus Vulpius Achilles tendon lengthening (VATL) in New Zealand White (NZW) rabbits.
Eight female NZW rabbits were used at 7 months of age. Two rabbits were euthanized before surgery for anatomical dissection, three underwent PATL (two bilateral and one unilateral), and the three others underwent VATL (two bilateral and one unilateral). Clinical examination, biomechanics, electromyography, standard radiographs and magnetic resonance imaging (MRI), and histology and histoenzymology were assessed after surgery.
At the end of the experiment, the subjects showed good clinical status but different functional outcomes of surgery: rabbits submitted to PATL developed permanent limp and lost their capacity to jump compared to rabbits submitted to VATL which remained able to ambulate and jump normally. Standard radiographs and MRI showed that PATL led to significantly greater increase in dorsal or anterior flexion of the tibiotarsal angle (TT angle) compared to VATL, whereas electromyographic and histoenzymologic observations of muscle unit showed little or no variation between the two groups of operated rabbits.
Although PATL leads to greater improvement in dorsal or anterior flexion (TT angle) of the rabbit ankle compared to VATL, it has negative effects on functional outcome as it reduces the contractile capacity of the rabbit muscle unit, ultimately impairing the ability to ambulate and jump.
本研究旨在描述新西兰白兔经皮跟腱延长术(PATL)与Vulpius跟腱延长术(VATL)对“腓肠肌 - 跟腱 - 跟骨复合体”造成的临床、放射学、生物力学、肌电图及组织酶学改变。
选用8只7月龄雌性新西兰白兔。2只在手术前安乐死用于解剖,3只接受PATL(2只双侧,1只单侧),另外3只接受VATL(2只双侧,1只单侧)。术后评估临床检查、生物力学、肌电图、标准X线片及磁共振成像(MRI),以及组织学和组织酶学。
实验结束时,受试动物临床状态良好,但手术功能结果不同:与接受VATL仍能正常行走和跳跃的兔子相比,接受PATL的兔子出现永久性跛行且失去跳跃能力。标准X线片和MRI显示,与VATL相比,PATL导致胫跗关节角(TT角)背屈或前屈显著增大,而两组手术兔子的肌电图和组织酶学观察显示肌肉单位变化很小或无变化。
尽管与VATL相比,PATL能使兔踝关节背屈或前屈(TT角)有更大改善,但对功能结果有负面影响,因为它降低了兔肌肉单位的收缩能力,最终损害行走和跳跃能力。