Sorrenti Samiul J
North Sydney Orthopaedic And Sports Medicine Centre, Sydney, NSW, Australia.
Foot Ankle Int. 2006 Jun;27(6):407-10. doi: 10.1177/107110070602700603.
Surgical and nonsurgical treatments of Achilles tendon ruptures are available. Nonsurgical treatment using immobilization does not have the varying degrees of infection as seen with surgical procedures, but it frequently is linked to muscle atrophy, weakness, and higher rates of rerupture than surgical treatment. This study reports the results of 64 patients with Achilles tendon ruptures treated surgically and with early mobilization.
Surgery of the ruptured tendon involved dividing the proximal stump into two separate strands and the distal stump into a single strand. The repair was advanced to a V-Y formation, and nonabsorbable sutures were used for repair. After wound closure, an early mobilization rehabilitation program was initiated, which consisted of wearing a moveable ankle brace for 4 to 6 weeks in 0 to 15 degrees of dorsiflexion and 10 weeks of regular exercises.
All 64 patients resumed normal activities in an average of 3.3 months regardless of whether the rupture was acute or chronic. Tendons healed with no reruptures. There were 13 complications, all wound infections, which healed when treated with antibiotics. The infection rate dropped markedly when wounds were inspected and dressings changed 1 week postoperatively, instead of at 2 weeks.
Surgery combined with early mobilization reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities. Applying tension to the tendon also improved strength of the calf muscles and improved ankle movement. The main concern with early mobilization is rerupture, but this was lessened by patients carefully following the weightbearing and early mobilization protocols. The results of this study strengthen the argument to employ early mobilization rehabilitation after surgical repair.
跟腱断裂有手术和非手术两种治疗方法。采用固定的非手术治疗不会出现手术治疗那样不同程度的感染，但它常常与肌肉萎缩、无力以及比手术治疗更高的再断裂发生率相关。本研究报告了64例接受手术及早期活动治疗的跟腱断裂患者的结果。
对断裂肌腱进行手术，将近端残端分成两股，远端残端分成一股。修复成V-Y形，使用不可吸收缝线进行修复。伤口闭合后，启动早期活动康复计划，包括佩戴可活动的踝关节支具4至6周，背屈角度为0至15度，并进行10周的常规锻炼。
64例患者均在平均3.3个月内恢复正常活动，无论断裂是急性还是慢性。肌腱愈合，无再断裂。有13例并发症，均为伤口感染，经抗生素治疗后愈合。术后1周而非2周检查伤口并更换敷料时，感染率显著下降。
手术结合早期活动可减少活动范围的丧失，增加血液供应，并减少跟腱断裂后通常出现的肌肉萎缩程度，从而缩短恢复正常活动的时间。对肌腱施加张力还可增强小腿肌肉力量并改善踝关节活动。早期活动的主要担忧是再断裂，但患者严格遵循负重和早期活动方案可减少这种情况。本研究结果支持在手术修复后采用早期活动康复的观点。
