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手术与保守治疗急性跟腱断裂：临床结果、运动学 MRI 和对比增强超声的初步结果。

Operative versus conservative treatment of acute Achilles tendon ruptures: preliminary results of clinical outcome, kinematic MRI and contrast-enhanced ultrasound.

机构信息

Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.

Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.

出版信息

Arch Orthop Trauma Surg. 2023 May;143(5):2455-2465. doi: 10.1007/s00402-022-04457-7. Epub 2022 May 14.

DOI:10.1007/s00402-022-04457-7
PMID:35567608
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10110640/
Abstract

INTRODUCTION

There is no uniform consensus on the gold standard therapy for acute Achilles tendon rupture. The aim of this pilot study was to compare operative and conservative treatment regarding imaging findings and clinical outcome.

MATERIALS AND METHODS

Surgically or conservatively treated patients with acute Achilles tendon rupture were retrospectively evaluated. Differences in tendon length and diameter with and without load were analysed using kinematic MRI, tendon perfusion, structural alterations, movement and scar tissue by means of grey-scale and contrast-enhanced ultrasound (CEUS). Intra- and interobserver agreement were recorded.

RESULTS

No significant difference was detected regarding clinical outcome, B mode ultrasonography, contrast-enhanced sonography or MRI findings, although alterations in MRI-based measurements of tendon elasticity were found for both groups. Considerable elongation and thickening of the injured tendon were detected in both groups.

CONCLUSION

Both, conservative and surgical treatment showed comparable outcomes in our preliminary results and may suggest non-inferiority of a conservative approach.

摘要

引言

对于急性跟腱断裂的黄金标准治疗方法尚未达成一致共识。本初步研究旨在比较手术治疗与保守治疗在影像学发现和临床结果方面的差异。

材料与方法

回顾性分析了接受急性跟腱断裂手术治疗或保守治疗的患者。使用运动 MRI 分析在负荷下和无负荷下的跟腱长度和直径差异、评估跟腱灌注、结构变化、运动和瘢痕组织情况，同时采用灰阶超声和对比增强超声（CEUS）。记录了观察者内和观察者间的一致性。

结果

尽管两组在基于 MRI 的肌腱弹性测量方面均存在变化，但在临床结果、B 型超声、对比增强超声或 MRI 发现方面，两组间均未检测到显著差异。两组患者的损伤跟腱均明显延长和增厚。

结论

在我们的初步研究结果中，保守治疗和手术治疗均显示出可比的结果，这可能表明保守治疗方法具有非劣效性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08d3/10110640/ebc3f679d236/402_2022_4457_Fig8_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08d3/10110640/823245c87947/402_2022_4457_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08d3/10110640/2ac97e739316/402_2022_4457_Fig6_HTML.jpg
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