Maffulli Nicola, Tallon Cheryl, Wong Jason, Lim Kim Peng, Bleakney Robert
Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Hartshill, Stoke on Trent, Staffordshire, England.
Am J Sports Med. 2003 Sep-Oct;31(5):692-700. doi: 10.1177/03635465030310051001.
To study the effects of early weightbearing and ankle mobilization after acute repair of ruptured Achilles tendon.
Comparative longitudinal study.
Patients in group 1 were postoperatively immobilized with their ankle in gravity equinus, they were encouraged to bear weight on the operated limb as soon as possible to full weightbearing, and they received a single cast change at 2 weeks, with the ankle accommodated in an anterior splint in a plantigrade position, allowing the ankle to be plantar flexed fully but not dorsiflexed above neutral. Patients in group 2 were immobilized with their ankle in full equinus with a cast change at 2 weeks, when the ankle was immobilized in mid equinus, and at 4 weeks, when the ankle was immobilized in a plantigrade position, and they were advised to bear weight.
Patients in group 1 attended fewer outpatient visits, completely discarded their crutches at an average of 2.5 weeks, and more were satisfied with the results of surgery. At ultrasonography, the average thickness of the repaired tendon was 12.1 mm, with no difference in the thickness of the ruptured tendon regardless of postoperative management. There was no significant difference in isometric strength between the two groups.
Early weightbearing with the ankle plantigrade is not detrimental to the outcome of repair after acute rupture of the Achilles tendon and shortens the time needed for rehabilitation. However, strength deficit and muscle atrophy are not prevented.
研究急性跟腱断裂修复术后早期负重及踝关节活动的效果。
比较性纵向研究。
第1组患者术后踝关节固定于重力性马蹄足位，鼓励其尽快在手术肢体上负重直至完全负重，2周时更换一次石膏，踝关节置于跖行位的前侧夹板中，允许踝关节充分跖屈但背屈不超过中立位。第2组患者踝关节固定于完全马蹄足位，2周时更换石膏，此时踝关节固定于中度马蹄足位，4周时踝关节固定于跖行位，并建议其负重。
第1组患者门诊就诊次数较少，平均在2.5周时完全丢弃拐杖，且对手术结果更满意。超声检查显示，修复后的肌腱平均厚度为12.1mm，无论术后处理方式如何，断裂肌腱的厚度均无差异。两组等长肌力无显著差异。
踝关节跖行位早期负重对急性跟腱断裂修复的结果并无不利影响，且缩短了康复所需时间。然而，无法预防力量不足和肌肉萎缩。
