非手术治疗的跟腱断裂早期拉伸负荷导致更大的肌腱骨痂和更低的弹性模量：一项随机对照试验。
Early Tensile Loading in Nonsurgically Treated Achilles Tendon Ruptures Leads to a Larger Tendon Callus and a Lower Elastic Modulus: A Randomized Controlled Trial.
机构信息
Orthopedic Department, Linköping University Hospital, Linköping, Sweden.
Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
出版信息
Am J Sports Med. 2022 Oct;50(12):3286-3298. doi: 10.1177/03635465221117780. Epub 2022 Aug 25.
BACKGROUND
Early tensile loading improves material properties of healing Achilles tendon ruptures in animal models and in surgically treated human ruptures. However, the effect of such rehabilitation in patients who are nonsurgically treated remains unknown.
HYPOTHESIS
In nonsurgically treated Achilles tendon ruptures, early tensile loading would lead to higher elastic modulus 19 weeks after the injury compared with controls.
STUDY DESIGN
Randomized controlled trial; Level of evidence, 2.
METHODS
Between October 2015 and November 2018, a total of 40 nonsurgically treated patients with acute Achilles tendon rupture were randomized to an early tensile loading (loaded group) or control group. Tantalum bead markers were inserted percutaneously into the tendon stumps 2 weeks after the injury to allow high-precision measurements of callus deformation under mechanical testing. The loaded group used a training pedal twice daily to produce a gradual increase in tensile load during the following 5 weeks. Both groups were allowed full weightbearing in an ankle orthosis and unloaded range of motion exercises. Patients were followed clinically and via roentgen stereophotogrammetric analysis and computed tomography at 7, 19, and 52 weeks after the injury.
RESULTS
The mean ± standard deviation elastic modulus at 19 weeks was 95.6 ± 38.2 MPa in the loaded group and 108 ± 45.2 MPa in controls ( = .37). The elastic modulus increased in both groups, although it was lower in the loaded group at all time points. Tendon cross-sectional area increased from 7 weeks to 19 weeks, from 231 ± 99.5 to 388 ± 142 mm in the loaded group and from 188 ± 65.4 to 335 ± 87.2 mm in controls ( < .001 for the effect of time). Cross-sectional area for the loaded group versus controls at 52 weeks was 302 ± 62.4 mm versus 252 ± 49.2 mm, respectively ( = .03). Gap elongation was 7.35 ± 13.9 mm in the loaded group versus 2.86 ± 5.52 mm in controls ( = .27).
CONCLUSION
Early tensile loading in nonsurgically treated Achilles tendon ruptures did not lead to higher elastic modulus in the healing tendon but altered the structural properties of the tendon via an increased tendon thickness.
REGISTRATION
NCT0280575 (ClinicalTrials.gov identifier).
背景
在动物模型和手术治疗的人类跟腱断裂中，早期拉伸载荷可改善愈合跟腱的材料特性。然而，对于非手术治疗的患者，这种康复的效果尚不清楚。
假设
在非手术治疗的跟腱断裂中，与对照组相比，受伤后 19 周时，早期拉伸载荷会导致更高的弹性模量。
研究设计
随机对照试验；证据水平，2 级。
方法
在 2015 年 10 月至 2018 年 11 月期间，共有 40 名非手术治疗的急性跟腱断裂患者被随机分为早期拉伸加载（加载组）或对照组。在受伤后 2 周，通过经皮插入钽珠标记物到肌腱残端，以允许在机械测试下对骨痂变形进行高精度测量。加载组使用训练踏板每天两次，以在接下来的 5 周内逐渐增加拉伸载荷。两组均允许在踝关节矫形器中完全负重，并进行无负荷运动练习。患者在受伤后 7、19 和 52 周时进行临床和 X 线立体摄影分析以及计算机断层扫描检查。
结果
加载组在 19 周时的平均±标准偏差弹性模量为 95.6±38.2MPa，对照组为 108±45.2MPa（ =.37）。两组的弹性模量均增加，但加载组在所有时间点的弹性模量均较低。跟腱横截面积从 7 周增加到 19 周，从加载组的 231±99.5 增加到 388±142mm，从对照组的 188±65.4 增加到 335±87.2mm（时间的影响<.001）。52 周时加载组与对照组的横截面积分别为 302±62.4mm 和 252±49.2mm（ =.03）。加载组的间隙伸长率为 7.35±13.9mm，对照组为 2.86±5.52mm（ =.27）。
结论
非手术治疗的跟腱断裂中早期拉伸载荷并未导致愈合肌腱的弹性模量升高，但通过增加肌腱厚度改变了肌腱的结构特性。
登记
NCT0280575（ClinicalTrials.gov 标识符）。
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