Longo Umile Giuseppe, Ronga Mario, Maffulli Nicola
Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy.
Sports Med Arthrosc Rev. 2009 Jun;17(2):112-26. doi: 10.1097/JSA.0b013e3181a3d625.
Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, sex, body weight and height, pes cavus, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and subsequent increase in noncollagenous matrix. Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles tendinopathy. Despite the morbidity associated with Achilles tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of stripping of neovessels from the Kager's triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the Achilles tendon, but these studies are still at their infancy.
跟腱病是导致残疾的常见原因。尽管该问题具有经济和社会相关性，但其病因和发病机制仍不明确。肌腱血管分布、腓肠肌-比目鱼肌功能障碍、年龄、性别、体重和身高、高弓足以及踝关节外侧不稳定被认为是常见的内在因素。跟腱病的本质是愈合反应失败，腱细胞随机增殖，肌腱细胞有一些退变迹象，胶原纤维破坏，随后非胶原基质增加。患肌腱病的肌腱基质重塑率增加，导致肌腱机械稳定性降低，更易受损。跟腱病的诊断主要基于详细的病史和全面的临床检查。后者仍是最佳诊断工具。在过去几年中，针对跟腱病的治疗提出了各种新的选择。尽管跟腱病会带来发病率，但许多已描述和常用的治疗方法远非基于科学依据。已描述了从跟腱的Kager三角区剥离新生血管的新型微创技术，这些技术似乎能使恢复更快，更快重返运动，而非开放手术。遗传因素与跟腱病有关，但这些研究仍处于起步阶段。
