| 急性闭合性跟腱断裂跟腱病理改变与超微结构研究 |
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投稿时间：2021-07-30
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| 作者 | Author | 单位 | Address | E-Mail |
| 黄鑫 |
HUANG Xin |
解放军总医院第四医学中心骨科学部, 北京 100048 |
Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital-Fourth Medical Center, Beijing 100148, China |
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| 苏柯 |
SU Ke |
解放军总医院第四医学中心骨科学部, 北京 100048 |
Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital-Fourth Medical Center, Beijing 100148, China |
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| 柳嘉伟 |
LIU Jia-wei |
解放军总医院第四医学中心骨科学部, 北京 100048 |
Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital-Fourth Medical Center, Beijing 100148, China |
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| 姜钰 |
JIANG Yu |
解放军总医院第四医学中心骨科学部, 北京 100048 |
Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital-Fourth Medical Center, Beijing 100148, China |
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| 朱颖波 |
ZHU Ying-bo |
解放军总医院第四医学中心骨科学部, 北京 100048 |
Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital-Fourth Medical Center, Beijing 100148, China |
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| 王晓宁 |
WANG Xiao-ning |
解放军总医院第四医学中心骨科学部, 北京 100048 |
Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital-Fourth Medical Center, Beijing 100148, China |
wxn304@126.com |
| 吴克俭 |
WU Ke-jian |
解放军总医院第四医学中心骨科学部, 北京 100048 |
Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital-Fourth Medical Center, Beijing 100148, China |
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| 期刊信息：《中国骨伤》2022年，第35卷，第1期，第5-10页 |
| DOI：10.12200/j.issn.1003-0034.2022.01.002 |
| 基金项目:304医院科研专项项目-跟腱断裂超微结构变化的研究（编号：2018FC-304M-CXYY-02）；军事训练伤防治研究专项课题：（编号：20XLS33） |
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中文摘要:
目的：探讨急性闭合性断裂跟腱组织形态学与超微结构变化。
方法：回顾分析2015年1月至2019年1月采用跟腱微创缝合技术治疗的急性跟腱断裂患者35例，其中急性开放性跟腱断裂12例，男10例，女2例，年龄19～50（35.1±9.7）岁，受伤至手术时间2～8（5.6±1.8） h。急性闭合性跟腱断裂23例，男21例，女2例，年龄18～50 （35.5±6.6）岁，受伤至手术时间3～15（7.5±3.1） h。于术前4～6 h通过肉眼观察及足踝部MRI比较两组患者跟腱组织断端的大体外观和影像学表现；于术后1～2 d对术中跟腱组织标本进行HE染色、扫描及透视电镜、免疫组化（天狼星红染色），分别比较两组跟腱组织的胶原纤维变性及局部脂肪浸润情况，胶原纤维走行及细胞形态、功能情况，Ⅰ型胶原纤维（collagenⅠ）和Ⅲ型胶原纤维（collagen Ⅲ）在组织中的分布情况。
结果：与急性开放性跟腱断裂组相比，急性闭合性跟腱断裂组跟腱组织弹性差、质地偏硬，中度水肿，跟腱断端形态不规则，呈马尾状且断端周围有较多钙化灶。HE染色结果：急性闭合性跟腱断裂组跟腱组织中胶原纤维排列不规则，有玻璃样变及脂肪侵润。电镜检查结果：急性闭合性跟腱断裂组胶原排列紊乱，成纤维细胞萎缩。免疫组化（天狼星染色）结果：急性开放性跟腱断裂组和急性闭合性跟腱断裂组Ⅰ型胶原占比分别为（91.12±4.34）%及（54.71±17.78）%，Ⅲ型胶原占比分别为（8.88±4.34）%及（45.29±17.78）%，急性闭合性跟腱断裂组Ⅰ型胶原含量低于急性闭开放跟腱断裂组，Ⅲ型胶原含量高于急性闭合性跟腱断裂组（P<0.05）。
结论：急性闭合性断裂跟腱形态组织学及超微结构发生明显改变，原本精细有序的空间结构无法维持，部分Ⅰ型胶原被Ⅲ型胶原替代，肌腱组织的韧性和强度下降，这是跟腱退行性变的重要特征，是闭合性跟腱断裂重要病理基础。 |
| 【关键词】急性跟腱断裂 形态学 组织学 超微结构 |
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| Comparative analysis of pathological structure between acute closed and open Achilles tendon rupture |
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ABSTRACT
Objective: To investigate the morphological,histological and ultrastructural changes of acute closed rupture of Achilles tendon,in order to clarify the pathological basis of the injury and to explore the significance.
Methods: From January 2015 to January 2019,35 patients with acute Achilles tendon rupture who underwent the minimally invasive Achilles tendon suture technique were retrospectively analyzed. Among these patients,12 cases in acute open Achilles tendon rupture group included 10 males and 2 females,with an average age of (35.1±9.7) years old ranging from 19 to 50,and the time from injury to operation was 2 to 8 hours with an average of(5.6±1.8);23 cases in acute closed Achilles tendon rupture group included 21 males and 2 females,with an average age of (35.5±6.6) years old ranging from 18 to 50,and the time from injury to operation was 3 to 15 hours with an average of (7.5±3.1). The gross appearance and imaging findings of the broken end of Achilles tendon tissue in the two groups were compared by naked eye observation and foot and ankle MRI at 4 to 6 hours before operation. HE staining,scanning and fluoroscopic electron microscopy,immunohistochemistry(Sirius red staining) were performed on the intraoperative Achilles tendon tissue specimens at 1 to 2 days after operation,the collagen fiber degeneration and local fat infiltration,collagen fiber shape,cell morphology and function,and the distribution of typeⅠand type Ⅲ collagen fibers in Achilles tendon were compared between the two groups.
Results: Compared with the acute open Achilles tendon rupture group,the acute closed Achilles tendon rupture group had poor elasticity,hard texture,moderate edema,irregular shape of Achilles tendon broken end,horsetail shape,and more calcification around the broken end. HE staining results:the collagen fibers in the Achilles tendon of the acute open Achilles tendon rupture group were arranged irregularly,with hyaline degeneration and fat infiltration;The results of electron microscopy showed that collagen arranged disorderly and fibroblasts atrophied in the acute closed Achilles tendon rupture group. Immunohistochemical(Sirius staining) results:the proportion of collagenⅠin the acute open Achilles tendon rupture group and the acute closed Achilles tendon rupture group was(91.12±4.34)% and(54.71±17.78)% respectively,and the proportion of collagen Ⅲ was (8.88±4.34)% and (45.29±17.78)% respectively. The content of collagenⅠin the acute closed Achilles tendon rupture group was lower than that in the acute open Achilles tendon rupture group,and the content of collagen Ⅲ in the acute closed Achilles tendon rupture group was higher than that in the acute open Achilles tendon rupture group(P<0.05).
Conclusion: The morphology,histology and ultrastructure of the acute closed ruptured Achilles tendon are significantly altered compared with the normal Achilles tendon. The original fine and orderly spatial structure cannot be maintained,part of collagen Ⅰ is replaced by collagen Ⅲ,and the toughness and strength of the tendon tissue decreased,which may be the feature of degeneration of the Achilles tendon and an important pathological basis for closed Achilles tendon rupture. |
| KEY WORDS Acute Achilles tendon rupture Morphology Histology Ultrastructure |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 黄鑫,苏柯,柳嘉伟,姜钰,朱颖波,王晓宁,吴克俭.急性闭合性跟腱断裂跟腱病理改变与超微结构研究[J].中国骨伤,2022,35(1):5~10 |
| 英文格式: | HUANG Xin,SU Ke,LIU Jia-wei,JIANG Yu,ZHU Ying-bo,WANG Xiao-ning,WU Ke-jian.Comparative analysis of pathological structure between acute closed and open Achilles tendon rupture[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(1):5~10 |
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