跟腱断裂术后制动与非制动对踝关节功能影响的临床与实验研究
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摘要
目的:探讨临床跟腱断裂术后制动对踝关节功能的影响及患肢制动对兔踝关节液中差异蛋白质表达的影响。方法:随访符合跟腱完全断裂诊断标准的35例患者,随机分成运动疗法组17例和制动组18例,用Cedell主客观踝关节功能评价标准随访两组患者的踝关节功能。选取健康新西兰白兔16只,随机分为制动组8只、运动组8只,两组家兔行单侧跟腱切断后伞式缝合法缝合,制动组给予患肢长腿石膏固定,运动组不予制动,于术后21天抽取两组患肢踝关节液,所获标本应用SELDI-TOF-MS技术分析不同模型踝关节液中差异蛋白质谱的表达。结果:(1)按Cedell评价标准,运动组优14例(81.3%),良3例(18.7%),优良率100%。制动组优10例,良5例,差3例,优良率83%。(2)运动组与制动组质谱数据经过初步筛选得到27个M/Z峰,其相对强度做Wilconxon秩和检验分析得到9个P值小于0.05的M/Z峰,从差异显著蛋白质峰的任意组合中,得到2个M/Z位于1235、1508Da的标志物,在制动组高表达,在运动组低表达。结论:运动疗法一定程度上减少跟腱断裂术后制动对踝关节功能的影响。制动组蛋白质峰的高表达说明踝关节液中产生了特异性的蛋白质,它可能引起一系列病理、生理变化,从而影响制动踝关节的功能。
Objective:To investigate the affects of immobilization to ankle joint function of postoperative clinical achilles tendon rupture.The change and significance of synovial fluid protein in ankle joint of immobilized rabbit.Methods:Follow up 35 cases with Achilles tendon rupture,were divided into two groups(17 cases of mobilized and 18 cases of immobilized).The ankle joint function was assessed with Cedell method. 16NewZealnad white rabbits were randomized to mobilized and immobilized group, 8rabbits respectively.Proteins in synovial fluid samples,which were obtained at the 21th day postoperatively,were measured by using Protein Chip~(TM)Array-Time of Flight Mass Spectrograph(SELDI-TOF-MS).Results:According to Cedell criteira 14 patients had the excellent results(81.3%),3patients had good results(18.7%),the percentage of excellent and good results were100%in mobilized group.10 patients had the excellent results(53%),5patients had good results(29%),3patients had poor results(18%),the percentage of excellent and good results were83%in immobilized group.Primarily screen out 27differential protein peaks in both group,9 proteins were significantly over expressed(P＜0.05),find two biomarkers at 1235,1508Da,over-expressed in immobilized group,weakly expressed in mobilized group.Conclusion:Exercise therapy some extent reduce the affect of immobilization to ankle joint function of postoperative achilles tendon rupture.It shows that there is a kind of special protein in synovial fluid of ankle joint of immobilized group,which can probably cause a series pathological and physiological changes to affect the function of immobilized ankle joint.
Objective:To investigate the affects of immobilization to ankle joint function of postoperative clinical achilles tendon rupture.The change and significance of synovial fluid protein in ankle joint of immobilized rabbit.Methods:Follow up 35 cases with Achilles tendon rupture,were divided into two groups(17 cases of mobilized and 18 cases of immobilized).The ankle joint function was assessed with Cedell method. 16NewZealnad white rabbits were randomized to mobilized and immobilized group, 8rabbits respectively.Proteins in synovial fluid samples,which were obtained at the 21th day postoperatively,were measured by using Protein Chip~(TM)Array-Time of Flight Mass Spectrograph(SELDI-TOF-MS).Results:According to Cedell criteira 14 patients had the excellent results(81.3%),3patients had good results(18.7%),the percentage of excellent and good results were100%in mobilized group.10 patients had the excellent results(53%),5patients had good results(29%),3patients had poor results(18%),the percentage of excellent and good results were83%in immobilized group.Primarily screen out 27differential protein peaks in both group,9 proteins were significantly over expressed(P＜0.05),find two biomarkers at 1235,1508Da,over-expressed in immobilized group,weakly expressed in mobilized group.Conclusion:Exercise therapy some extent reduce the affect of immobilization to ankle joint function of postoperative achilles tendon rupture.It shows that there is a kind of special protein in synovial fluid of ankle joint of immobilized group,which can probably cause a series pathological and physiological changes to affect the function of immobilized ankle joint.
引文
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