阿基里斯肌腱斷裂常見於運動員與久坐的患者身上，且糖尿病可能會提高其發生的機率，對於急性阿基里斯斯腱的斷裂時裂口兩端的修復，可靠的軟組織固定是必要的。手術縫合可以提供癒合初期良好的固定，並且得到較好的功能性恢復，然而糖尿病患在免疫與癒合能力受到影響，是否能適用於手術治療及其療效仍待商榷。回顧目前的文獻並沒有對於高血糖狀況下阿基里斯腱斷裂，使用手術縫合與未手術縫合，對於癒合過程的影響，根據力學特性及功能性恢復進行探討。
本實驗使用高血糖鼠與正常鼠兩組，各組再細分為Modified Bunnell縫法組與控制組並且在術後癒合第四、七、十四、二十一天使用功能性評估以及力學測試為依據來評量。
本實驗結果發現在相同年齡下高血糖鼠與正常鼠的肌腱抗拉強度相似，但高血糖鼠之勁度較低，且抗拉強度與勁度均與年齡有顯著相關。在離體試驗中證實，Modified Bunnell縫法比起傳統的Bunnell縫法能提供更佳的力學強度。在術後第七天，藉由肌腱解剖外觀、組織切片以及力學強度的變化，可推測在高血糖鼠上其增生期受到了遲緩。高血糖的狀況會影響阿基里斯功能性指數與踝關節活動度變差，在高血糖的狀態下Modified Bunnell縫法縫法的癒合效果受到影響，與正常血糖相比，在力學強度與功能性上均有下降。但也發現在高血糖的狀態下未縫合與正常血糖相比，其惡化程度會比縫合更加劇烈。且在高血糖的狀況下使用Modified Bunnell縫法，其癒合效果比起切斷不縫合，在力學強度與功能性上均有增加。結果顯示在高血糖鼠上Modified Bunnell 縫法可適用於修復阿基里斯肌腱，且相較於正常大鼠更為重要。

Complete rupture of the Achilles tendon can be experienced by both sedentary patients and athletes, and diabetes patients may experience higher risk of rupture. Secure soft-tissue fixation is essential to direct end-to-end repair for acute tendon rupture. Surgical suture tendon repair can provide good fixation at early healing stage, and get a well performance of function. However, diabetes could affect patient’s immunity and healing abilities, so there are some doubts about the suitability and the result of surgical suture tendon repair for diabetes patients. The suitability and the result of surgical suture on Achilles tendon repair for diabetes have rarely been reported and interpreted so far. The purpose of this study was to investigate the in vivo efficacy and the suitability of Modified Bunnell suture method for Achilles tendon repair in euglycemic and hyperglycemic rats by temporal mechanical, functional and histological evaluation.
Male Sprague-Dawley rats with Achilles tendon rupture were randomly assigned into four groups of treatments: (1) Repaired with modified Bunnell suture method on normal rats (2) No repair on normal rats (3) Repaired with with modified Bunnell suture on hyperglycemic rats (4) No repair on hyperglycemic rats. The functional recovery of rats and the mechanical properties of healing tendon were evaluated at 4, 7, 14, and 21 days postoperatively.
The results showed that the Achilles tendon of euglycemic and hyperglycemic rats have similar tensile strength, but the stiffness of hyperglycemic rats Achilles tendon was worse than euglycemic rats. The tensile strength and stiffness of rat Achilles tendons were correlated with age in all groups. Modified Bunnell suture method provided stronger tensile strength and stiffness than conventional Bunnell suture method in ex-vivo study. In vivo study, the delay of the proliferative phase in hyperglycemic rats was perceptible by the histological observation and the change of the mechanical properties at 7 days postoperatively. The hyperglycemia could affect the Achilles functional index and the ankle joint angle. The hyperglycemic group had less mechanical properties and functional activities than normal group with Modified Bunnell suture. The hyperglycemic group with Modified Bunnell suture got better mechanical properties and functional activities than no repair. The results of this study suggested that using Modified Bunnell suture method on Achilles tendon injury in hyperglycemic rats had better results.

Ahmed, Z., Underwood, S., & Brown, R. A. (2000). Low concentrations of fibrinogen increase cell migration speed on fibronectin/fibrinogen composite cables. Cell Motil Cytoskeleton, 46(1), 6-16.
Arner, O., Lindholm, A., & Orell, S. R. (1959). Histologic changes in subcutaneous rupture of the Achilles tendon; a study of 74 cases. Acta Chir Scand, 116(5-6), 484-490.
American Diabetes Association (2009). Diagnosis and classification of diabetes mellitus. Diabetes Care, 32 Suppl 1, S62-67.
Effect of an additional peptide extension of the N-terminus of collagen from dermatosparactic calves on the cross-linking of the collagen fibres, 91-96 (1973).
Bain, J. R., Mackinnon, S. E., & Hunter, D. A. (1989). Functional evaluation of complete sciatic, peroneal, and posterior tibial nerve lesions in the rat. Plast Reconstr Surg, 83(1), 129-138.
Batista, F., Nery, C., Pinzur, M., Monteiro, A. C., de Souza, E. F., Felippe, F. H., et al. (2008). Achilles tendinopathy in diabetes mellitus. Foot Ankle Int, 29(5), 498-501.
Bedi, A., Fox, A. J., Harris, P. E., Deng, X. H., Ying, L., Warren, R. F., et al. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg.
Bergljung, L. (1968). Vascular reactions after tendon suture and tendon transplantation. A stereo-microangiographic study on the calcaneal tendon of the rabbit. Scand J Plast Reconstr Surg Suppl, 4, 7-63.
Beskin, J. L., Sanders, R. A., Hunter, S. C., & Hughston, J. C. (1987). Surgical repair of Achilles tendon ruptures. Am J Sports Med, 15(1), 1-8.
Best, T. M., Collins, A., Lilly, E. G., Seaber, A. V., Goldner, R., & Murrell, G. A. (1993). Achilles tendon healing: a correlation between functional and mechanical performance in the rat. J Orthop Res, 11(6), 897-906.
Bolzan, A. D., & Bianchi, M. S. (2002). Genotoxicity of streptozotocin. Mutat Res, 512(2-3), 121-134.
Bono, V. H., Jr. (1976). Review of mechanism of action studies of the nitrosoureas. Cancer Treat Rep, 60(6), 699-702.
Bradley, J. P., & Tibone, J. E. (1990). Percutaneous and open surgical repairs of Achilles tendon ruptures. A comparative study. Am J Sports Med, 18(2), 188-195.
Chbinou, N., & Frenette, J. (2004). Insulin-dependent diabetes impairs the inflammatory response and delays angiogenesis following Achilles tendon injury. Am J Physiol Regul Integr Comp Physiol, 286(5), R952-957.
Coombs, R. R. H., Klenerman, L., Narcisi, P., Nichols, A., & Pope, F. M. (1980). Collagen typing in Achilles tendon rupture. In Proceedings of the British Orthopaedic Research. Society. J. Bone and Joint Surg, 62(258).
Dent, C. M., & Graham, G. P. (1991). Osteogenesis imperfecta and Achilles tendon rupture. Injury, 22(3), 239-240.
Dodds, W. N., & Burry, H. C. (1984). The relationship between Achilles tendon rupture and serum uric acid level. Injury, 16, 94-95.
Dogan, S., Demirer, S., Kepenekci, I., Erkek, B., Kiziltay, A., Hasirci, N., et al. (2009). Epidermal growth factor-containing wound closure enhances wound healing in non-diabetic and diabetic rats. Int Wound J, 6(2), 107-115.
Ejeskar, A., & Irstam, L. (1981). Elongation in profundus tendon repair. A clinical and radiological study. Scand J Plast Reconstr Surg, 15(1), 61-68.
Gelberman, R. H., Boyer, M. I., Brodt, M. D., Winters, S. C., & Silva, M. J. (1999). The Effect of Gap Formation at the Repair Site on the Strength and Excursion of Intrasynovial Flexor Tendons. AN EXPERIMENTAL STUDY ON THE EARLY STAGES OF TENDON-HEALING IN DOGS. J Bone Joint Surg Am, 81(7), 975-982.
Grant, W. P., Sullivan, R., Sonenshine, D. E., Adam, M., Slusser, J. H., Carson, K. A., et al. (1997). Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. J Foot Ankle Surg, 36(4), 272-278; discussion 330.
Hagberg, L., & Selvik, G. (1991). Tendon excursion and dehiscence during early controlled mobilization after flexor tendon repair in zone II: an x-ray stereophotogrammetric analysis. J Hand Surg Am, 16(4), 669-680.
Herbort, M., Haber, A., Zantop, T., Gosheger, G., Rosslenbroich, S., Raschke, M. J., et al. (2008). Biomechanical comparison of the primary stability of suturing Achilles tendon rupture: a cadaver study of Bunnell and Kessler techniques under cyclic loading conditions. Arch Orthop Trauma Surg, 128(11), 1273-1277.
Junod, A., Lambert, A. E., Stauffacher, W., & Renold, A. E. (1969). Diabetogenic action of streptozotocin: relationship of dose to metabolic response. J Clin Invest, 48(11), 2129-2139.
Ketchum, L. D. (1977). Primary tendon healing: a review. J Hand Surg Am, 2(6), 428-435.
Komesu, M. C., Tanga, M. B., Buttros, K. R., & Nakao, C. (2004). Effects of acute diabetes on rat cutaneous wound healing. Pathophysiology, 11(2), 63-67.
Kuwada, G. T. (1995). Diagnosis and treatment of Achilles tendon rupture. Clin Podiatr Med Surg, 12(4), 633-652.
Lagergren, C., & Lindholm, A. (1959). Vascular distribution in the Achilles tendon; an angiographic and microangiographic study. Acta Chir Scand, 116(5-6), 491-495.
Lenzen, S., & Panten, U. (1988). Alloxan: history and mechanism of action. Diabetologia, 31(6), 337-342.
Leppilahti, J., & Orava, S. (1998). Total Achilles tendon rupture. A review. Sports Med, 25(2), 79-100.
Liang, J.-I., Liu, C.-Y., Hsieh, T.-H., Chen, J.-J. J., Chen, M.-Y., & Yeh, M.-L. (2009). SENSIBILITY EVALUATION for ASSESSMENT of ACHILLES TENDON REPAIR in RATS by FUNCTIONAL INDEX and GAIT ANALYSIS SYSTEM: A PILOT STUDY. Paper presented at the 2009 International Symposium on Biomechanics combined with the Annual Scientific Meeting of Taiwanese Society of Biomechanics.
Maffulli, N., Irwin, A. S., Kenward, M. G., Smith, F., & Porter, R. W. (1998). Achilles tendon rupture and sciatica: a possible correlation. Br J Sports Med, 32(2), 174-177.
McMaster, P. E. (1933). Tendon and muscle ruptures. Clinical and experimental studies on the causes and location of subcutaneous ruptures. J. Bone and Joint Surg., 15,July, 705-722.
Morrison, E. Y., Ragoobirsingh, D., Thompson, H., Fletcher, C., Smith-Richardson, S., McFarlane, S., et al. (1995). Phasic insulin dependent diabetes mellitus: manifestations and cellular mechanisms. J Clin Endocrinol Metab, 80(7), 1996-2001.
Murrell, G. A., Lilly, E. G., Davies, H., Best, T. M., Goldner, R. D., & Seaber, A. V. (1992). The Achilles Functional Index. J Orthop Res, 10(3), 398-404.
O'Brien, M. (1992). Functional anatomy and physiology of tendons. Clin Sports Med, 11(3), 505-520.
Reale, E., Benazzo, F., & Ruggeri, A. (1981). Differences in the microfibrillar arrangement of collagen fibrils. Distribution and possible significance. J Submicrosc Cytol, 13(2), 135-143.
Reddy, G. K. (2003). Glucose-mediated in vitro glycation modulates biomechanical integrity of the soft tissues but not hard tissues. J Orthop Res, 21(4), 738-743.
Rees, D. A., & Alcolado, J. C. (2005). Animal models of diabetes mellitus. Diabet Med, 22(4), 359-370.
Robins, S. P. (1988). Functional properties of collagen and elastin. Baillieres Clin Rheumatol, 2(1), 1-36.
Rupp, S., Tempelhof, S., & Fritsch, E. (1995). Ultrasound of the Achilles tendon after surgical repair: morphology and function. Br J Radiol, 68(809), 454-458.
Schmidt-Rohlfing, B., Graf, J., Schneider, U., & Niethard, F. U. (1992). The blood supply of the Achilles tendon. Int Orthop, 16(1), 29-31.
Seradge, H. (1983). Elongation of the repair configuration following flexor tendon repair. J Hand Surg Am, 8(2), 182-185.
Silfverskiold, K. L., May, E. J., & Tornvall, A. H. (1992). Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study. J Hand Surg Am, 17(3), 539-546.
Tanil, Y. Y. E. (2002). Initial pull-out strength of tendon sutures: An in vitro study in sheep Achilles tendon. Foot & ankle international, vol. 23(no12), 1126-1130.
Varejao, A. S., Cabrita, A. M., Meek, M. F., Bulas-Cruz, J., Gabriel, R. C., Filipe, V. M., et al. (2002). Motion of the foot and ankle during the stance phase in rats. Muscle Nerve, 26(5), 630-635.
Wang, Z., & Gleichmann, H. (1998). GLUT2 in pancreatic islets: crucial target molecule in diabetes induced with multiple low doses of streptozotocin in mice. Diabetes, 47(1), 50-56.
Zahner, D., & Malaisse, W. J. (1990). Kinetic behaviour of liver glucokinase in diabetes. I. Alteration in streptozotocin-diabetic rats. Diabetes Res, 14(3), 101-108.
Zobitz, M. E., Zhao, C., Erhard, L., Amadio, P. C., & An, K. N. (2001). Tensile properties of suture methods for repair of partially lacerated human flexor tendon in vitro. J Hand Surg Am, 26(5), 821-827.
林高田(1984)。以動力性壓迫縫合法縫合肌腱之生物力學及臨床研究。碩士論文，高雄醫學大學，高雄市。
周婉婷(2009)。使用老鼠模型以力學及功能性評估指數評估不同縫合技術對損傷阿基里斯腱癒合之影響。碩士論文，國立成功大學，台南。