Järvinen T A, Kannus P, Paavola M, Järvinen T L, Józsa L, Järvinen M
Institute of Medical Technology and Medical School, University of Tampere, Tampere, Finland.
Curr Opin Rheumatol. 2001 Mar;13(2):150-5. doi: 10.1097/00002281-200103000-00009.
The Achilles tendon is the strongest tendon in the human body. Because most Achilles tendon injuries take place in sports and there has been an common upsurge in sporting activities, the number and incidence of the Achilles tendon overuse injuries and complete ruptures have increased in the industrialized countries during the last decades. The most common clinical diagnosis of Achilles overuse injuries is tendinopathy, which is characterized by a combination of pain and swelling in the Achilles tendon accompanied by impaired ability to perform strenuous activities. Most patients with Achilles tendon injury respond favorably to conservative treatment and only those who fail to respond to carefully followed nonoperative treatment should undergo surgery for repair. A complete rupture of the Achilles tendon usually occurs in sports that require jumping, running, and quick turns. Although histopathologic studies have shown that ruptured Achilles tendons include clear degenerative changes before the rupture, many of the Achilles tendon ruptures occur suddenly without any preceding signs or symptoms. Neither conservative nor operative treatment is a treatment of choice for the ruptured Achilles tendon. It is generally accepted that surgery should be performed on ruptured Achilles tendons in young, physically active patients and in those patients for whom the diagnosis or the treatment of the rupture has been delayed, whereas the results of conservative treatment are an acceptable outcome in older patients with sedentary lifestyles. Many important issues still remain unanswered concerning the cause, pathogenesis, diagnosis, and management of the Achilles tendon disorders. Only when these issues have been solved by well-controlled studies can tailored treatment protocols be created.
跟腱是人体最强壮的肌腱。由于大多数跟腱损伤发生在体育运动中，且体育活动普遍增多，在过去几十年里，工业化国家跟腱过度使用损伤和完全断裂的数量及发生率都有所增加。跟腱过度使用损伤最常见的临床诊断是肌腱病，其特征是跟腱疼痛和肿胀同时出现，伴有进行剧烈活动的能力受损。大多数跟腱损伤患者对保守治疗反应良好，只有那些对严格遵循的非手术治疗无反应的患者才应接受手术修复。跟腱完全断裂通常发生在需要跳跃、跑步和快速转身的运动中。尽管组织病理学研究表明，断裂前的跟腱存在明显的退行性改变，但许多跟腱断裂是突然发生的，没有任何前驱症状。对于断裂的跟腱，保守治疗和手术治疗都不是首选。一般认为，年轻、身体活跃的患者以及诊断或治疗延迟的患者的跟腱断裂应进行手术，而对于久坐不动的老年患者，保守治疗的结果是可以接受的。关于跟腱疾病的病因、发病机制、诊断和管理，许多重要问题仍然没有答案。只有通过严格控制的研究解决这些问题，才能制定出针对性的治疗方案。
