等速肌力测试法评估腱周膜下通道技术治疗急性跟腱断裂疗效的研究

Isokinetic evaluation of muscle strength and endurance after treatment of acute Achilles tendon rupture using a tunnel beneath paratenon

目的观察采用等速肌力测试客观评价腱周膜下通道技术治疗急性跟腱断裂术后肌力及耐力的恢复。方法回顾性研究解放军总医院第四医学中心骨科自2017年1月至2018年1月采用腱周膜下通道技术治疗的23例急性跟腱断裂患者资料。其中男22例,女1例;年龄26~60岁,平均35.7岁;右侧11例,左侧12例;伤后0.5~7.0 d(平均2.7 d)行手术治疗。术后18个月收集切口长度、皮肤坏死、感染、再断裂情况,并对健侧与患侧踝关节进行等速肌力测试,从而客观评价手术治疗效果。结果所有患者均未出现皮肤坏死、感染及再断裂,切口长度平均1.4 cm(1~2 cm)。AOFAS的踝-后足评分平均99.1分(93~100分),总体优良率为100%(23/23);ATRS评分平均97.0分(88~100分)。等速肌力测试显示患侧踝关节跖屈扭矩峰值和背伸扭矩峰值在5个测试速度下(30、60、90、120、240°/s)与健侧比较,差异均无统计学意义(P>0.05)。耐力测试中,踝关节健侧与患侧跖屈总功分别为(691.2±258.8)、(670.6±304.2)J,差异均无统计学意义(P>0.05);踝关节健侧背伸总功[(407.3±119.2)J]大于患侧[(362.2±117.5)J],差异有统计学意义(P=0.001)。结论等速肌力测试法可以客观评价腱周膜下通道技术治疗急性跟腱断裂的治疗效果。

Objective To use an isokinetic test to objectively evaluate the recovery of muscle strength and endurance after treatment of acute Achilles tendon rupture using a tunnel beneath paratenon.Methods A retrospective study was conducted of the 23 patients who had been treated at Department of Orthopedics,The Forth Medical Center,General Hospital of Chinese PLA by a tunnel beneath paratenon for acute Achilles tendon rupture from January 2017 to January 2018.They were 22 males and one female,aged from 26 to 60 years(average,35.7 years),with 11 right and 12 left sides involved.Surgery was performed 0.5 to 7.0 days(average,2.7 days)after injury.Length of incision,skin necrosis,infection,re-rupture,ankle-hindfoot score of American Orthopedic Foot&Ankle Society(AOFAS)and Achilles tendon total rupture scores(ATRS)were followed up for 18 months.Surgical outcomes were objectively evaluated by an isokinetic test to compare the recovery of muscle strength and endurance between the affected and normal sides.Results Skin necrosis,infection or re-rupture occurred in none of the patients.Incision length averaged 1.4 cm(from 1 to 2 cm),AOFAS 99.1(from 93 to 100,giving an excellent and good rate of 100%),and ATRS 97.0(from 88 to 100).Isokinetic evaluation showed that the peak torques of ankle plantar flexion and dorsal extension at 5 test speeds(30°/s,60°/s,90°/s,120°/s and 240°/s)were not significantly different between the affected and normal sides(P>0.05).In the endurance test,the total work of ankle plantar flexion was(691.2±258.8)J on the normal side and(670.6±304.2)J on the affected side,showing no significant difference between the 2 sides(P>0.05);the total work of ankle dorsal extension at the normal side was(407.3±119.2)J,significantly larger than that at the affected side[(362.2±117.5)J](P=0.001).Conclusion An isokinetic test can be used to objectively evaluate the recovery of muscle strength and endurance after treatment of acute Achilles tendon rupture using a tunnel beneath paratenon.