高频超声对肌腱损伤修复的评估:自身对照动物实验方案

High-frequency ultrasound in the assessment of tendon injury and repair: study protocol for a self-controlled animal trial

背景:肌腱损伤是临床的常见疾病,外科吻合是治疗该疾病的常用手段。临床实践中,由于MRI检查费用昂贵及应用的限制,对于肌腱吻合后肌腱愈合情况的跟踪治疗长期靠临床医生的经验评估,一直缺乏便捷、准确的临床影像学支持。近些年,随着高频超声的改进和临床应用的增多,极大提高了闭合性肌腱损伤的诊断率,使得高频超声应用于肌腱损伤及修复后的评估成为临床研究的热点。目的:采用高频超声与组织学检查相结合的方式,找到损伤肌腱修复过程中的超声影像学特点。方法:研究为单中心、前瞻性、自身对照动物实验,将在中国四平市中心人民医院完成。实验选用SD大鼠130只,随机分为13组,每组10只。每只大鼠随机选一侧后足为手术肢,另一侧肢体为对照肢。对手术肢跟腱进行切断,第1组不予缝合,而第2-13组均按Kessler法吻合;第8-13组于外科吻合后第1天起,每日进行术肢肌腱屈伸活动数次的被动功能锻炼。于肌腱切断前和切断后(第1组),以及外科吻合后3,7,14,21,35,42 d分别对第2及8组、3及9组、4及10组、5及11组、6及12组、7及13组动物肌腱进行高频超声检查和苏木精-伊红染色。结果与结论:实验的主要观察指标为高频超声观察的损伤肌腱修复、愈合情况;次要观察指标为苏木精-伊红染色检测的损伤肌腱组织病理学表现。实验结果将为高频超声应用于肌腱损伤、修复、愈合过程临床评估提供临床前数据,并为进一步开展促进肌腱功能恢复的康复程序提供依据。

BACKGROUND： Tendon injury is common in clinic, which is mainly treated by surgical anastomosis. Postoperative tendon healing is usually assessed through surgeons＇ experience due to high cost and application restrictions of MRI examination. Thus there is still a lack of a convenient and objective imaging support. With the advancement and widespread application of high-frequency ultrasound, the diagnosis rate of tendon injury has been improved remarkably; thereafter, high-frequency ultrasound used for assessing tendon injury and repair has become an issuehas become an issue of concern.OBJECTIVE： To clarify the ultrasonic imaging features of tendon repair through high-frequency ultrasound scancombined with histological examination.METHODS： This was a single-central, preoperative and self-controlled animal experiment and finished in the Central People＇sHospital of Siping, China. 130 adult male Highbrow chickens were selected and were then randomized into 13 groups （n=10per group）. One side of each chicken hind foot was randomly selected as experimental limb to undergo achillotomy followedby repair using the modified Kessler method （groups 2-13） or no treatment （group 1）; the contralateral limb served as control.Moreover, passive flexion-extension functional training targeting the experimental limbs was performed in the groups 8-13beginning at the 1st day after surgical anastomosis, several times a day. The high-frequency ultrasound and hematoxylineosinstaining were conducted before and after chillotomy （group 1）, and at 3 （groups 2 and 8）, 7 （groups 3 and 9）, 14 （groups4 and 10）, 21 （groups 5 and 11）, 35 （groups 6 and 12） and 42 （groups 7 and 13） days after surgical anastomosis, respectively.RESULTS AND CONCLUSION： The primary measurement outcomes were the repair and healing of the injured tendonas assessed by high-frequency ultrasound; the secondary outcomes were the pathological manifestations of the injuredtendon detected by hematoxylin-eosin staining. Our findings will provide preclinical proof for high-frequency ultrasounduse in the assessment of tendon injury, repair and healing as well as for the rehabilitation therapy that promotes functionrecovery in the future.