Influence of preoperative blood lipid profiles on postoperative recovery in patients with acute Achilles tendon rupture
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摘要:
目的 探讨术前血脂水平对急性跟腱断裂（AATR）患者术后恢复的影响 方法 回顾性分析2021年1月至2024年1月我院创伤骨科收治的353例AATR患者的临床资料，包括患者的一般临床资料及术前空腹状态下血生化相关指标记录术后半年时患者的跟腱完全断裂评分（ATRS）和美国足踝矫形外科协会（AOFAS）踝- 后足功能评分，并进行分组：ATRS≥80分为术后恢复良好组，ATRS＜80分为术后恢复不良组；AOFAS评分≥90分为术后恢复良组，AOFAS评分＜90分为术后恢复不良组采用单因素和多因素logistic回归分析患者术后恢复的影响因素 结果 按ATRS分组中，术后恢复良好组患者的血清甘油三酯（TG）、总胆固醇（TC）和低密度脂蛋白（LDL）水平低于术后恢复不良组（均P＜0.05）；按AOFAS评分组中，术后恢复良好组患者的血清TG、TC水平低于术后恢复不良组（均P＜0.05）单因素logistic回归分析结果显示，按ATRS分组中，血清TG、TC、LDL水平升高是AATR患者术后恢复不良的危险因素（均P＜0.05）；按AOFAS评分分组中，血清TG、TC水平升高是AATR患者术后恢复不良的危险因素（均P＜0.05）多因素logistic回归分析结果显示，血清LDL水平升高是AATR患者术后恢复不良的独立危险因素（P＜0.05） 结论 术前血清LDL水平升高与AATR患者术后恢复不良的风险增加有关对AATR患者进行术前血脂管理，可能对其术后功能恢复具有积极作用 Abstract:Objective To investigate the influence of preoperative blood lipid levels on postoperative recovery in patients with acute Achilles tendon rupture (AATR). Methods The clinical data of 353 AATR patients treated in Department of Orthopaedics Trauma of our hospital from Jan. 2021 to Jan. 2024 were retrospectively analyzed, including general clinical information and preoperative fasting blood biochemistry indices. Patients' Achilles tendon total rupture score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were recorded 6 months postoperatively. Postoperative recovery was categorized as favorable if ATRS≥80 and poor if ATRS < 80; similarly, recovery was considered favorable if AOFAS score ≥90 and poor if AOFAS score < 90. Univariate and multivariate logistic regression analyses were done to investigate the influencing factors of patients' postoperative recovery. Results When categorized by ATRS, patients in the favorable postoperative recovery group exhibited significantly lower serum levels of triglyceride (TG), total cholesterol (TC), and low-density lipoprotein (LDL) compared to the poor postoperative recovery group (all P < 0.05). Similarly, when categorized by AOFAS score, the favorable postoperative recovery group had lower serum TG and TC levels than the poor postoperative recovery group (both P < 0.05). Univariate logistic regression analysis demonstrated that in the ATRS grouping, elevated serum levels of TG, TC and LDL were significantly associated with an increased risk of poor postoperative recovery in AATR patients (all P < 0.05). Similarly, in the AOFAS score grouping, elevated serum levels of TG and TC were significantly correlated with an increased risk of poor postoperative recovery in AATR patients (both P < 0.05). Multivariate logistic regression analysis further identified that high serum LDL level was an independent predictor of poor postoperative recovery in AATR patients (P < 0.05). Conclusion High preoperative serum LDL level is associated with an increased risk of poor postoperative recovery in AATR patients. Therefore, preoperative blood lipid management in AATR patients may have positive effects on postoperative functional recovery. -
Keywords:
- Achilles tendon rupture /
- low-density lipoprotein /
- risk factors /
- perioperative period /
- prognosis
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急性跟腱断裂（acute Achilles tendon rupture，AATR）是运动医学领域一种常见且严重的损伤，在竞技体育领域，它可能会对运动员的职业生涯造成毁灭性打击；在普通人群中，它也会严重干扰休闲运动爱好者的日常生活，影响其活动能力和生活质量。此类损伤恢复周期较长，临床治疗方案主要为保守治疗和手术治疗[1]。保守治疗虽有一定优势，但存在跟腱恢复周期长、再断裂风险高等局限性。相比之下，传统开放式手术不仅能实现跟腱的精准牢固修复，还具有操作简便、效果显著的优势。特别是近年来随着手术技术的持续创新，如采用改良Kessler缝合法后，患者术后功能恢复良好，并发症发生率显著降低，疗效确切[2]。但是仍有部分患者会面临术后恢复周期长、踝关节活动受限等困扰日常生活的问题。鉴于上述情况，探究影响AATR患者术后恢复的因素，尤其是术前可调控的因素，对于优化围手术期管理、改善患者预后具有重要意义。
血脂水平对骨科疾病患者术后恢复的影响已成为临床研究热点之一。研究显示，血清总胆固醇（total cholesterol，TC）、低密度脂蛋白（low-densitylipoprotein，LDL）水平升高可能是股骨颈骨折AO中空加压螺纹钉内固定术后患者并发股骨头缺血性坏死的危险因素[3]。在脊柱外科领域，TC、LDL、高密度脂蛋白（high-density lipoprotein，HDL）水平异常亦被证实与L1~L4椎体骨折患者康复进程密切相关，其中氧化型LDL胆固醇可抑制成骨细胞分化，减少骨组织血液灌注，从而阻碍骨折愈合[4]。术前血清甘油三酯（triglyceride，TG）、TC高水平及载脂蛋白（apolipoprotein，Apo）A1低水平可能是膝关节炎全膝关节置换术后患者恢复不良的危险因素[5]。既往研究发现，空腹尿酸、TC、TG等血清学指标升高与跟腱断裂风险增加有关[6]。然而，目前尚不清楚血脂水平对AATR患者术后恢复的具体作用。本研究旨在探讨AATR患者术前空腹血脂水平对术后恢复的影响，以期为优化AATR患者围手术期管理策略、促进术后康复提供理论依据。
1 资料和方法
1.1 研究对象
本研究为病例对照研究，选取2021年1月至2024年1月在我院创伤骨科确诊为AATR并接受改良Kessler缝合法手术治疗的患者353例作为研究对象。纳入标准：（1）经临床症状、体征及影像学检查确诊为单侧AATR，病程在1周以内；（2）损伤类型为闭合性损伤；（3）跟腱断裂部位距离跟骨结节≥3 cm；（4）患者术后半年内能够按时进行门诊复查，并配合完成相关评估。排除标准：（1）双侧跟腱断裂或合并有其他损伤；（2）跟腱断裂病程≥1周，考虑为陈旧性损伤；（3）开放性跟腱断裂；（4）跟腱断裂部位距离跟骨结节＜3 cm；（5）术后半年未定期复查导致资料缺失者；（6）合并有其他严重疾病，如严重糖尿病、血脂严重异常、严重心脑血管疾病或严重肝肾功能不全等。
1.2 资料收集
收集患者的性别、年龄、身高、体重、BMI。所有患者入院后次日晨起空腹（禁食至少10 h）采集血液标本，检测术前血清指标，包括TG、TC、HDL、LDL、Apo A1、Apo B、血糖水平。术后半年患者于门诊复查时，采用跟腱完全断裂评分（Achilles tendon total rupture score，ATRS）和美国足踝矫形外科协会（American Orthopaedic Footand Ankle Society，AOFAS）踝- 后足功能评分对患者恢复情况进行评估。ATRS≥80分记为术后恢复良好，ATRS＜80分记为术后恢复不良；AOFAS评分≥90分记为术后恢复良好，AOFAS评分＜90分记为术后恢复不良。
1.3 手术方法
均采用椎管内麻醉，或椎管内麻醉+神经阻滞麻醉。患者麻醉成功后取俯卧位，于大腿根部扎止血带。抬高患肢并使用驱血带驱血，随后将止血带充气至30~35 kPa。以跟腱断裂处为中心，做一长约3~5 cm纵行切口，暴露跟腱断端并标记两侧断端。在近端跟腱断端上方约5 cm处用尖刀于跟腱两侧各做一长约0.5 cm切口，用5号尼龙缝线由外侧切口横穿至内侧切口，缝线以45°从跟腱中部走行，于近端断端内引出。将缝线穿入远端跟腱断端，于断端约5 cm处内侧穿出，并于同一水平外侧做一长约0.5 cm切口，将缝线由内向外横穿跟腱，再次从跟腱中部走行，最终于远端断端穿出，与缝线尾部交会。在近端跟腱断端上方约3~4 cm处重复上述操作，使不同距离穿入的2根缝线于断端交汇，同时打结收紧。用2-0可吸收缝线间断加强缝合3~6针，彻底冲洗伤口后，逐层缝合关闭切口。
1.4 术后管理
术后踝关节跖屈位短腿石膏固定2周，然后改为功能位石膏固定2周。4周后拆除石膏进行踝关节跖屈和背伸锻炼，6周后穿足跟垫高支具进行部分负重的下地行走，8周后逐渐恢复下肢负重行走，12周后完全恢复下肢负重行走。通过门诊复查随访指导患者术后功能锻炼。
1.5 统计学处理
应用SPSS 25.0软件进行统计学分析。计量资料以 x±s表示，组间比较采用t检验；计数资料以例数表示，组间比较采用χ2检验或Fisher确切概率法。将单因素logistic分析中P＜0.05的变量纳入多因素logistic回归分析，筛选AATR患者术后恢复的影响因素。检验水准（α）为0.05。
2 结果
2.1 患者一般资料比较
根据ATRS评估AATR患者的术后恢复情况，272例患者术后恢复良好（ATRS≥80分），81例术后恢复不良（ATRS＜80分），术后恢复良好组患者的血清TG、TC和LDL水平低于恢复不良组，差异有统计学意义（均P＜0.05）。根据AOFAS评分评估AATR患者的术后恢复情况，281例患者术后恢复良好（AOFAS评分≥90分），72例术后恢复不良（AOFAS评分＜90分），术后恢复良好组患者的血清TG、TC水平低于恢复不良组，差异有统计学意义（均P＜0.05）。无论按ATRS分组还是按AOFAS评分分组，两组患者在性别、年龄、BMI、HDL、Apo A1、Apo B及空腹血糖方面的差异均无统计学意义（均P＞0.05）。见表 1。
表 1 根据ATRS和AOFAS评分分组的AATR患者一般资料比较Table 1 Comparison of baseline characteristics in AATR patients stratified by ATRS or AOFAS score assessmentIndex ATRS assessmenta Favorable N＝ 272 Poor N＝ 81 Statistic P value Gender, n Fisher's exact test 0.624 Male 268 79 Female 4 2 Age/year, x±s 37.71 ± 7.45 38.42 ± 6.70 t = 0.774 0.440 BMI/(kg·m-2), x±s 25.58 ± 2.63 25.74 ± 2.47 t = 0.485 0.628 TG/(mmol·L-1), x±s 1.68 ± 0.34 1.82 ± 0.46 t = 2.589 0.011 TC/(mmol·L-1), x±s 4.37 ± 0.96 4.66 ± 0.95 t = 2.418 0.016 HDL/(mmol·L-1), x±s 1.43 ± 0.36 1.47 ± 0.37 t = 0.920 0.358 LDL/(mmol·L-1), x±s 2.89 ± 0.48 3.05 ± 0.55 t = 2.428 0.017 Apo A1/(mmol·L-1), x±s 1.43 ± 0.24 1.41 ± 0.26 t = -0.732 0.465 Apo B/(mmol·L-1), x±s 1.11 ± 0.26 1.14 ± 0.25 t = 1.048 0.295 FBG/(mmol·L-1), x±s 5.84 ± 0.86 5.99 ± 0.83 t = 1.462 0.145 Index AOFAS score assessmentb Favorable N＝ 281 Poor N＝ 72 Statistic P value Gender, n Fisher's exact test 0.606 Male 277 70 Female 4 2 Age/year, x±s 37.66 ± 7.43 38.68 ± 6.66 t = 1.059 0.290 BMI/(kg·m-2), x±s 25.60 ± 2.64 25.67 ± 2.45 t = 0.187 0.852 TG/(mmol·L-1), x±s 1.68 ± 0.35 1.82 ± 0.47 t = 2.346 0.021 TC/(mmol·L-1), x±s 4.38 ± 0.96 4.66 ± 0.94 t = 2.229 0.026 HDL/(mmol·L-1), x±s 1.42 ± 0.36 1.49 ± 0.36 t = 1.509 0.132 LDL/(mmol·L-1), x±s 2.91 ± 0.49 2.98 ± 0.54 t = 0.989 0.323 Apo A1/(mmol·L-1), x±s 1.44 ± 0.25 1.39 ± 0.26 t = -1.428 0.154 Apo B/(mmol·L-1), x±s 1.11 ± 0.26 1.15 ± 0.25 t = 1.381 0.168 FBG/(mmol·L-1), x±s 5.86 ± 0.85 5.94 ± 0.86 t = 0.743 0.458 a: Postoperative recovery was categorized as favorable if ATRS≥80 and poor if ATRS＜80; b: Postoperative recovery was categorized as favorable if AOFAS score≥90 and poor if AOFAS score＜90. ATRS: Achilles tendon total rupture score; AOFAS: American Orthopaedic Foot and Ankle Society; AATR: Acute Achilles tendon rupture; BMI: Body mass index; TG: Triglyceride; TC: Total cholesterol; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; Apo: Apolipoprotein; FBG: Fasting blood glucose. 2.2 AATR患者术后恢复的单因素logistic回归分析
将术后恢复良好与恢复不良作为因变量，以年龄、BMI、TG、TC、HDL、LDL、ApoA1、Apo B、空腹血糖为自变量，纳入logistic回归模型进行分析。变量赋值：ATRS≥80分赋值为1，ATRS＜80分赋值为0；AOFAS评分≥90分赋值为1，AOFAS评分＜90分赋值为0。
单因素logistic回归分析结果显示，按ATRS分组中，血清TG、TC、LDL水平升高是AATR患者术后恢复不良的危险因素（均P＜0.05），见表 2；按AOFAS评分分组中，血清TG和TC水平升高是AATR患者术后恢复不良的危险因素（均P＜0.05），见表 3。
表 2 基于ATRS评估的AATR患者术后恢复的单因素logistic回归分析Table 2 Univariate logistic regression analysis of postoperative recovery in AATR patients stratified by ATRS assessmentVariable b SE OR (95% CI) P value Age −0.013 0.017 0.987 (0.954, 1.021) 0.439 BMI −0.240 0.049 0.977 (0.887, 1.075) 0.627 TG −0.963 0.327 0.382 (0.201, 0.725) 0.003 TC −0.320 0.134 0.726 (0.559, 0.944) 0.017 HDL −0.324 0.353 0.723 (0.362, 1.443) 0.357 LDL −0.652 0.254 0.521 (0.316, 0.857) 0.010 Apo A1 0.376 0.513 1.456 (0.533, 3.976) 0.464 Apo B −0.517 0.494 0.596 (0.227, 1.569) 0.295 FBG −0.219 0.150 0.804 (0.599, 1.078) 0.145 ATRS: Achilles tendon total rupture score; AATR: Acute Achilles tendon rupture; BMI: Body mass index; TG: Triglyceride; TC: Total cholesterol; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; Apo: Apolipoprotein; FBG: Fasting blood glucose; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. 表 3 基于AOFAS评分评估的AATR患者术后恢复的单因素logistic回归分析Table 3 Univariate logistic regression analysis of postoperative recovery in AATR patients stratified by AOFAS score assessmentVariable b SE OR (95% CI) P value Age −0.019 0.018 0.981 (0.947, 1.017) 0.290 BMI −0.010 0.051 0.991 (0.896, 1.094) 0.851 TG −0.920 0.337 0.399 (0.206, 0.772) 0.006 TC −0.308 0.140 0.735 (0.559, 0.967) 0.028 HDL −0.557 0.370 0.573 (0.277, 1.184) 0.113 LDL −0.259 0.262 0.772 (0.461, 1.290) 0.323 Apo A1 0.767 0.539 2.152 (0.749, 6.184) 0.155 Apo B −0.712 0.517 0.490 (0.178, 1.352) 0.168 FBG −0.116 0.156 0.891 (0.657, 1.208) 0.457 AOFAS: American Orthopaedic Foot and Ankle Society; AATR: Acute Achilles tendon rupture; BMI: Body mass index; TG: Triglyceride; TC: Total cholesterol; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; Apo: Apolipoprotein; FBG: Fasting blood glucose; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. 2.3 AATR患者术后恢复的多因素logistic回归分析
按ATRS分组中，将术后恢复良好与恢复不良作为因变量，以TG、TC、LDL为自变量，进行多因素logistic回归分析，结果显示血清LDL水平升高是AATR患者术后恢复不良的危险因素（P＜0.05），见表 4。
表 4 基于ATRS评估的AATR患者术后恢复的多因素logistic回归分析Table 4 Multivariate logistic regression analysis of postoperative recovery in AATR patients stratified by ATRS assessmentVariable b SE OR (95% CI) P value TG −1.499 0.801 0.223 (0.046, 1.073) 0.061 TC 0.188 0.324 1.206 (0.640, 2.275) 0.562 LDL −0.751 0.262 0.472 (0.283, 0.789) 0.004 ATRS: Achilles tendon total rupture score; AATR: Acute Achilles tendon rupture; TG: Triglyceride; TC: Total cholesterol; LDL: Low-density lipoprotein; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. 按AOFAS评分分组中，将术后恢复良好与恢复不良作为因变量，以TG、TC为自变量，进行多因素logistic回归分析，结果显示血清TG、TC水平升高与AATR患者术后恢复不良无统计学相关性（P＞0.05），见表 5。
表 5 基于AOFAS评分评估的AATR患者术后恢复的多因素logistic回归分析Table 5 Multivariate logistic regression analysis of postoperative recovery in AATR patients stratified by AOFAS score assessmentVariable b SE OR (95% CI) P value TG −1.326 0.799 0.266 (0.055, 1.272) 0.097 TC 0.183 0.327 1.201 (0.633, 2.281) 0.575 AOFAS: American Orthopaedic Foot and Ankle Society; AATR: Acute Achilles tendon rupture; TG: Triglyceride; TC: Total cholesterol; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. 3 讨论
本研究旨在探讨术前血生化指标对AATR患者术后恢复的影响。多因素logistic回归分析结果表明，血清LDL水平升高是术后患者ATRS降低的独立危险因素，这一发现为AATR患者的围术期管理提供了重要的临床参考依据，同时也引发了我们对AATR患者术后恢复相关因素的进一步思考。
血脂异常影响AATR患者术后恢复的具体机制尚不完全清楚。已有研究显示，高脂血症与跟腱断裂及术后并发症密切相关[7]。血清LDL水平与部分跟腱疾病的发病存在相关性。家族性高胆固醇血症作为最常见的遗传代谢疾病之一，是由一组遗传性疾病所引起，其典型特征为血脂重要成分之一的LDL水平异常升高[8]。这种升高会促使动脉粥样硬化斑块沉积，进而增加血栓形成的风险[9]。小血栓、闭塞性动脉疾病和血流量减少会扰乱肌腱的微血管系统，造成局部血液循环不足。局部血液循环不畅可进一步导致组织缺氧，同时使营养和能量代谢受到损害。这些不利因素相互叠加，极有可能在AATR患者术后恢复过程中发挥重要作用[10]。肌腱黄瘤（tendinous xanthoma，TX）主要由脂质和单核细胞衍生的泡沫细胞组成，通常由脂蛋白代谢紊乱引起[11]，且与冠状动脉粥样硬化存在独立关联，血脂水平的异常可能也会造成跟腱结构的改变[12-15]。TX是部分肌腱（主要是跟腱和手部的伸肌肌腱）内的脂质沉积物，会导致肌腱产生弥漫性或局灶性增厚，易引发炎症，偶尔也会导致疼痛与功能障碍[16]。既往研究发现，TX在家族性高胆固醇血症患者中表现出一定的特异性[8]，但是也有部分家族性高胆固醇血症患者不会发生TX，目前的研究尚不能很好地解释这一现象，这可能与巨噬细胞对氧化型LDL颗粒的炎症反应存在个体差异有关[17]。然而Harada等[18]和Murano等[19]的研究发现，家族性高胆固醇血症患者血清中胆固醇的浓度与跟腱断裂之间存在相关性，而TX患者发生跟腱断裂也较为常见。也有研究显示，跟腱断裂患者的血清胆固醇、TG和LDL水平均高于健康人群，提示患者体内异常升高的特定血脂成分可能对跟腱的结构产生不利影响[20]。一项meta分析的结果同样显示跟腱结构变化和跟腱疼痛与TG、TC、LDL胆固醇水平升高以及HDL胆固醇水平降低有关[21]。跟腱损伤通常与其机械结构有关。跟腱主干的70% 是胶原蛋白，其中95% 为Ⅰ型胶原蛋白[22-23]。人们最初认为Ⅰ型胶原蛋白组装成纤维是一个自发和熵驱动的过程，然而有研究表明，胶原纤维的形成受细胞的密切调控，并与纤连蛋白的组装动态结合[24]。此外，有脂质沉积的血管平滑肌细胞（即平滑肌泡沫细胞）会导致胶原蛋白聚合异常，降低细胞胶原纤维的组装能力。这进一步改变了跟腱的结构，导致其强度降低[25-26]，这或许是影响血脂异常的跟腱术后患者功能恢复的重要原因。本研究结果表明，术前血脂水平在AATR患者的术后恢复中扮演着关键角色。多因素logistic回归分析结果显示，血清LDL水平升高与患者术后恢复不良相关。这一结果与既往研究结果[7]相符，进一步表明血脂异常，尤其是LDL水平升高对AATR患者恢复的不利影响。推测可能与动脉粥样硬化影响跟腱局部血液循环，进而干扰术后跟腱组织修复过程中的营养供应和能量代谢有关。
在手术方法及术后管理方面，本研究中所有患者均采用改良Kessler缝合法进行手术治疗，并遵循统一的术后康复方案，这在一定程度上控制了手术操作及术后早期处理对研究结果的影响。然而，我们也意识到不同手术技巧及术后康复训练的个体差异可能对最终结果产生潜在的影响。如手术过程中缝线的张力调整、打结方式以及术后早期康复训练的强度和频率等因素，虽然在本研究中未进行深入探讨，但在实际临床工作中可能会对患者的术后恢复产生重要影响。
本研究中，虽然单因素分析结果显示ATRS评估术后恢复良好组与恢复不良组患者血清TG、TC和LDL水平存在显著差异，AOFAS评分评估术后恢复良好组与恢复不良组患者血清TG和TC水平存在显著差异，但在多因素logistic分析中，以AOFAS评分评估时，血清TG、TC水平升高与患者术后恢复无明显关联。这一现象提示不同的评分系统在评估AATR患者术后恢复情况时可能具有不同的侧重点和敏感性。ATRS和AOFAS评分在评估跟腱修复术后的功能恢复情况时具有较好的相关性，两者具有相似的评估效果，然而AOFAS评分评估相对客观，ATRS在评估跟腱术后康复效果时，由患者自评，有一定的主观性。因此，联合使用量表的评估方法将研究者的客观评估与患者的主观感受进行有效结合，可以使评估结果更全面、更准确[27]。
本研究存在一定的局限性。一方面，本研究采用回顾性调查设计，虽能发现变量间的相关性，但无法证实因果关系，需进一步开展前瞻性调查研究加以验证。另一方面，患者术前血清中的指标除血糖、血脂外，还有其他代谢产物，如尿酸等，这些也可能影响患者术后恢复，但本研究未予涉及，有待进一步探索。此外，本研究仅收集了术前血脂、血糖等数据，缺乏术后动态监测数据，故无法了解这些指标在术后恢复过程中的变化规律以及它们对预后的长期影响，未来研究应设计更为全面的监测方案，包括术前及术后定期检测相关指标，从而更深入地探究其与AATR患者术后恢复的关系。
综上所述，术前血清LDL水平升高是AATR患者术后恢复不良的危险因素，因此对AATR患者进行术前血脂管理有利于患者术后功能的恢复。
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表 1 根据ATRS和AOFAS评分分组的AATR患者一般资料比较
Table 1 Comparison of baseline characteristics in AATR patients stratified by ATRS or AOFAS score assessment
Index ATRS assessmenta Favorable N＝ 272 Poor N＝ 81 Statistic P value Gender, n Fisher's exact test 0.624 Male 268 79 Female 4 2 Age/year, x±s 37.71 ± 7.45 38.42 ± 6.70 t = 0.774 0.440 BMI/(kg·m-2), x±s 25.58 ± 2.63 25.74 ± 2.47 t = 0.485 0.628 TG/(mmol·L-1), x±s 1.68 ± 0.34 1.82 ± 0.46 t = 2.589 0.011 TC/(mmol·L-1), x±s 4.37 ± 0.96 4.66 ± 0.95 t = 2.418 0.016 HDL/(mmol·L-1), x±s 1.43 ± 0.36 1.47 ± 0.37 t = 0.920 0.358 LDL/(mmol·L-1), x±s 2.89 ± 0.48 3.05 ± 0.55 t = 2.428 0.017 Apo A1/(mmol·L-1), x±s 1.43 ± 0.24 1.41 ± 0.26 t = -0.732 0.465 Apo B/(mmol·L-1), x±s 1.11 ± 0.26 1.14 ± 0.25 t = 1.048 0.295 FBG/(mmol·L-1), x±s 5.84 ± 0.86 5.99 ± 0.83 t = 1.462 0.145 Index AOFAS score assessmentb Favorable N＝ 281 Poor N＝ 72 Statistic P value Gender, n Fisher's exact test 0.606 Male 277 70 Female 4 2 Age/year, x±s 37.66 ± 7.43 38.68 ± 6.66 t = 1.059 0.290 BMI/(kg·m-2), x±s 25.60 ± 2.64 25.67 ± 2.45 t = 0.187 0.852 TG/(mmol·L-1), x±s 1.68 ± 0.35 1.82 ± 0.47 t = 2.346 0.021 TC/(mmol·L-1), x±s 4.38 ± 0.96 4.66 ± 0.94 t = 2.229 0.026 HDL/(mmol·L-1), x±s 1.42 ± 0.36 1.49 ± 0.36 t = 1.509 0.132 LDL/(mmol·L-1), x±s 2.91 ± 0.49 2.98 ± 0.54 t = 0.989 0.323 Apo A1/(mmol·L-1), x±s 1.44 ± 0.25 1.39 ± 0.26 t = -1.428 0.154 Apo B/(mmol·L-1), x±s 1.11 ± 0.26 1.15 ± 0.25 t = 1.381 0.168 FBG/(mmol·L-1), x±s 5.86 ± 0.85 5.94 ± 0.86 t = 0.743 0.458 a: Postoperative recovery was categorized as favorable if ATRS≥80 and poor if ATRS＜80; b: Postoperative recovery was categorized as favorable if AOFAS score≥90 and poor if AOFAS score＜90. ATRS: Achilles tendon total rupture score; AOFAS: American Orthopaedic Foot and Ankle Society; AATR: Acute Achilles tendon rupture; BMI: Body mass index; TG: Triglyceride; TC: Total cholesterol; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; Apo: Apolipoprotein; FBG: Fasting blood glucose. 表 2 基于ATRS评估的AATR患者术后恢复的单因素logistic回归分析
Table 2 Univariate logistic regression analysis of postoperative recovery in AATR patients stratified by ATRS assessment
Variable b SE OR (95% CI) P value Age −0.013 0.017 0.987 (0.954, 1.021) 0.439 BMI −0.240 0.049 0.977 (0.887, 1.075) 0.627 TG −0.963 0.327 0.382 (0.201, 0.725) 0.003 TC −0.320 0.134 0.726 (0.559, 0.944) 0.017 HDL −0.324 0.353 0.723 (0.362, 1.443) 0.357 LDL −0.652 0.254 0.521 (0.316, 0.857) 0.010 Apo A1 0.376 0.513 1.456 (0.533, 3.976) 0.464 Apo B −0.517 0.494 0.596 (0.227, 1.569) 0.295 FBG −0.219 0.150 0.804 (0.599, 1.078) 0.145 ATRS: Achilles tendon total rupture score; AATR: Acute Achilles tendon rupture; BMI: Body mass index; TG: Triglyceride; TC: Total cholesterol; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; Apo: Apolipoprotein; FBG: Fasting blood glucose; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. 表 3 基于AOFAS评分评估的AATR患者术后恢复的单因素logistic回归分析
Table 3 Univariate logistic regression analysis of postoperative recovery in AATR patients stratified by AOFAS score assessment
Variable b SE OR (95% CI) P value Age −0.019 0.018 0.981 (0.947, 1.017) 0.290 BMI −0.010 0.051 0.991 (0.896, 1.094) 0.851 TG −0.920 0.337 0.399 (0.206, 0.772) 0.006 TC −0.308 0.140 0.735 (0.559, 0.967) 0.028 HDL −0.557 0.370 0.573 (0.277, 1.184) 0.113 LDL −0.259 0.262 0.772 (0.461, 1.290) 0.323 Apo A1 0.767 0.539 2.152 (0.749, 6.184) 0.155 Apo B −0.712 0.517 0.490 (0.178, 1.352) 0.168 FBG −0.116 0.156 0.891 (0.657, 1.208) 0.457 AOFAS: American Orthopaedic Foot and Ankle Society; AATR: Acute Achilles tendon rupture; BMI: Body mass index; TG: Triglyceride; TC: Total cholesterol; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; Apo: Apolipoprotein; FBG: Fasting blood glucose; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. 表 4 基于ATRS评估的AATR患者术后恢复的多因素logistic回归分析
Table 4 Multivariate logistic regression analysis of postoperative recovery in AATR patients stratified by ATRS assessment
Variable b SE OR (95% CI) P value TG −1.499 0.801 0.223 (0.046, 1.073) 0.061 TC 0.188 0.324 1.206 (0.640, 2.275) 0.562 LDL −0.751 0.262 0.472 (0.283, 0.789) 0.004 ATRS: Achilles tendon total rupture score; AATR: Acute Achilles tendon rupture; TG: Triglyceride; TC: Total cholesterol; LDL: Low-density lipoprotein; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. 表 5 基于AOFAS评分评估的AATR患者术后恢复的多因素logistic回归分析
Table 5 Multivariate logistic regression analysis of postoperative recovery in AATR patients stratified by AOFAS score assessment
Variable b SE OR (95% CI) P value TG −1.326 0.799 0.266 (0.055, 1.272) 0.097 TC 0.183 0.327 1.201 (0.633, 2.281) 0.575 AOFAS: American Orthopaedic Foot and Ankle Society; AATR: Acute Achilles tendon rupture; TG: Triglyceride; TC: Total cholesterol; b: Regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval. -
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