急性闭合性跟腱断裂预后与Ⅲ型胶原比例的关系研究  

The relationship between the prognosis of acute closed Achilles tendon rupture and the proportion of type Ⅲ collagen

作　　者：苏柯 柳嘉伟 黄鑫[2] 朱颖波[2] 王晓宁[2] SU Ke;LIU Jia-wei;HUANG Xin;ZHU Ying-bo;WANG Xiao-ning(Department of Orthopedics,Xijing Hospital Air Force Medical University,Xi＇an,Shaanxi,7 10032,China)

机构地区：[1]空军军医大学西京医院骨科,西安710032 [2]解放军总医院第一附属医院骨科,北京100048

出　　处：《中国骨与关节杂志》2018年第10期788-792,共5页Chinese Journal of Bone and Joint

基　　金：首都临床特色应用研究与成果推广(Z151100004015012)

摘　　要：目的探讨急性闭合性跟腱断裂患者Ⅲ型胶原比例的高低与其临床预后之间的关系。方法2015年1月至2016年10月我科共收治急性闭合性跟腱断裂患者41例,其中男39例,女2例,年龄20~55岁,平均36.2岁;左侧23例,右侧18例。损伤部位:距离跟骨结节4.5~6.0 cm。采用自行研制的微创跟腱缝合技术和器材进行手术治疗,伤后至手术时间为1~6天,平均2.2天,术中取断端局部横断面病理标本(距断裂位置<0.3 cm)做天狼猩红染色,计算每个患者跟腱胶原中Ⅲ型胶原的比例,并按照其比例高低分为四组:A组0%~25%,B组26%~50%,C组51%~75%,D组76%~100%)。术后随访12~18个月,平均16.8个月,根据Arner-Lindholm评定法进行预后评分。结果四组终末随访预后评定均达到优良水平,但术后6个月却有明显差异,A组共10例,优5例,良2例,差3例,总体优良率70%;B组共14例,优11例,良3例,总体优良率100%;C组共12例,优10例,良2例,总体优良率100%;D组共5例,优1例,良2例,差2例,总体优良率60%;术后6个月随访功能评定,A组与D组间优良率差异无统计学意义(P>0.05),A组优良率明显低于B组、C组,差异有统计学意义(P=0.018);B组与C组间优良率差异无统计学意义(P>0.05);D组优良率明显低于B组、C组,差异有统计学意义(P=0.009)。结论对急性闭合性跟腱断裂患者,由同一组医师进行相同的手术及术后康复指导,四组患者自身跟腱Ⅲ型胶原的比例不同,可能会导致功能恢复速度和程度有明显差异,Ⅲ型胶原比例过高或者过低的患者恢复较慢。Objective To investigate the relationship between the proportion of type Ⅲ collagen and the clinical prognosis of acute closed Achilles tendon rupture. Methods From January 2015 to October 2016, 41 patients（ 39 males and 2 females; 23 cases on the left side and 18 cases on the right side） with acute closed Achilles tendon rupture were included. The average age was 36.2 years（ range： 20-55 years）. Acute closed Achilles tendon rupture was confirmed by clinical physical examination and MRI. Injury site： 4.5-6.0 cm from the calcaneus tubercle. Selfdeveloped technology and equipment for minimally invasive Achilles tendon suture surgery were applied. The average time from injury to operation was 2.2 d（ range： 1-6 d）. Stump pathological specimens were obtained during surgery（ less than 0.3 cm from the fracture location）. Sirius red staining was conducted, and type Ⅲ collagen ratio was calculated. According to the proportion of type Ⅲ collagen, all were divided into 4 groups（ Group A 0%-25%, Group B 26%-50%, Group C 51%-75%, Group D 76%-100%）. All patients were followed up for 12-18 months, with an average of 16.8 months. The prognosis was evaluated by Arner-Lindholm. Differences between the groups were analyzed by SPSS18.0 software. Results The prognostic results of the four groups were excellent, but there were significant differences 6 months later. Group A（ n = 10）： excellent in 5 cases, good in 2 cases, poor in 3 cases, overall excellent and good rate 70%; Group B（ n = 14）： excellent in 11 cases, good in 3 cases, overall excellent rate 100%; Group C（ n = 12）： excellent in 10 cases, good in 2 cases, overall excellent rate 100%; Group D（ n = 5）： excellent in 1 case, good in 2 cases, poor in 2 cases, overall excellent and good rate 60%. Six months postoperatively, there were no significant differences between Group A and the Group B（ P〈0.05）; The excellent rate of Group A was significantly lower than that in Group B and Group C（ P = 0.018）; There were no

关 键 词：跟腱 急性病 腱损伤 胶原Ⅲ型 预后 

分 类 号：R687.2[医药卫生—骨科学]