Alexa O, Veliceasa B, Puha C, Popia I
Disciplina Ortopedie-Traumatologie, Facultatea de Medicină, Universitatea de Medicină Si Farmacie Gr.T. Popa" Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2008 Oct-Dec;112(4):993-8.
The treatment of the acute ruptures of the achillean tendon remains controversial. For the time being, there is no consent regarding the ideal therapeutic approach. The therapeutical procedure for the recent achilean tendon tears varies between two possible solutions, one conservative and the other surgical. The choice between these is made based on the type of rupture and the experience of the surgeon. The conservative techniques can have good results in selected cases, but they produce a degree of elongation of the tendon, which may lead to improper functional results. The classical surgical treatment (the open technique) has the handicap of a relatively large, longitudinal incision, which is made in an area with relatively poor skin vascular supply. Also, the vascular supply of the tendon itself is based mainly on perforant, subfascial vessels, which are intercepted during the approach. Taking these facts into consideration, some new, minimally invasive (percutaneous) techniques, were imagined. The principles of the standard percutaneous technique consist of: 1) union of the ruptured ends without using a large surgical approach, thus also avoiding the drainage of the local hematoma and rushing the repair; 2) avoiding damaging of the tendon's vascular supply. This techique leads to a rapid transformation of the collagen fibers into elastic fibers, which are mechanically effective. We present in this paper the method which uses the TENOLIG kit. This kit consists of two wires with anchors at one end and needles at the other end; two washers and two poliethylene disks for securing the distal end of the wire. We obtained good morphological (proven by MRI scan) and functional results with this technique. The postoperative protocol includes immobilization with the foot initially in equinous, then in normal position, with isometric muscle contractions and non-weight-bearing, then removal of the cast and wires at 45 days postoperatively and continuing the recovery by kinetotherapy.
跟腱急性断裂的治疗仍存在争议。目前，对于理想的治疗方法尚无共识。近期跟腱断裂的治疗程序在两种可能的解决方案之间有所不同，一种是保守治疗，另一种是手术治疗。两者之间的选择基于断裂类型和外科医生的经验。保守技术在某些选定病例中可能会取得良好效果，但会导致肌腱一定程度的延长，这可能会导致功能结果不佳。传统的手术治疗（开放技术）存在一个缺点，即需要在皮肤血供相对较差的区域做一个相对较大的纵向切口。此外，肌腱本身的血供主要基于穿通的、筋膜下血管，在手术入路过程中这些血管会被截断。考虑到这些事实，人们设想了一些新的微创（经皮）技术。标准经皮技术的原则包括：1）不采用大的手术入路使断裂端愈合，从而也避免局部血肿引流和匆忙修复；2）避免损伤肌腱的血供。这种技术能使胶原纤维迅速转化为弹性纤维，在力学上是有效的。我们在本文中介绍使用TENOLIG套件的方法。该套件由两根一端带有锚定器、另一端带有针的线；两个垫圈和两个用于固定线远端的聚乙烯盘组成。我们使用这种技术获得了良好的形态学（经MRI扫描证实）和功能结果。术后方案包括最初将足部固定在马蹄内翻位，然后固定在正常位置，进行等长肌肉收缩和不负重，术后45天拆除石膏和线，然后通过运动疗法继续恢复。
