Best T M, Collins A, Lilly E G, Seaber A V, Goldner R, Murrell G A
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710.
J Orthop Res. 1993 Nov;11(6):897-906. doi: 10.1002/jor.1100110617.
The pathogenesis and treatment of rupture of the Achilles tendon remain a source of controversy. This study presents the results of a biomechanical, functional, and morphological evaluation of a group of rats that had division and repair of the Achilles tendon. A total of 46 rats were used: 18 for biomechanical testing, 18 for functional evaluation, and 10 for histology. Morphological examination revealed an early inflammatory response with loose connective tissue formation that was replaced gradually by fibroblasts and a collagenous matrix. The functional evaluation (Achilles functional index [AFI]) was made from measurements of the hind pawprints of walking rats. Division and repair of the Achilles tendon produced a significant functional impairment (mean [+/- SEM] AFI = -87 +/- 8; p < 0.001), which gradually improved with healing time. The load to failure for the repaired tendons consistently improved with healing time, in a manner similar to the functional recovery. The average deformation (repair/control) varied considerably and was not related to healing time. The stiffness of the repaired tendons increased with healing time and was 60% of the corresponding control side by day 15. The major finding of this study was a strong correlation between the AFI and the failure load of the healing tendon-bone constructs (250-300 g group, r = 0.97, p < 0.001; 325-375 g group, r = 0.96, p < 0.001).
跟腱断裂的发病机制及治疗方法仍存在争议。本研究展示了一组跟腱被切断并修复的大鼠的生物力学、功能及形态学评估结果。总共使用了46只大鼠：18只用于生物力学测试，18只用于功能评估，10只用于组织学研究。形态学检查显示早期存在炎症反应，伴有疏松结缔组织形成，随后逐渐被成纤维细胞和胶原基质取代。功能评估（跟腱功能指数[AFI]）通过测量行走大鼠的后爪印得出。跟腱切断并修复后产生了显著的功能损害（平均[±标准误]AFI = -87 ± 8；p < 0.001），随着愈合时间的推移逐渐改善。修复肌腱的断裂负荷随愈合时间持续改善，方式与功能恢复相似。平均变形（修复/对照）差异很大，且与愈合时间无关。修复肌腱的刚度随愈合时间增加，到第15天时为相应对照侧的60%。本研究的主要发现是AFI与愈合的肌腱-骨结构的断裂负荷之间存在强相关性（250 - 300克组，r = 0.97，p < 0.001；325 - 375克组，r = 0.96，p < 0.001）。
