Hüfner T, Gaulke R, Imrecke J, Krettek C, Stübig T
Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Unfallchirurg. 2010 Sep;113(9):699-702, 704. doi: 10.1007/s00113-010-1833-5.
The conservative functional treatment of Achilles tendon ruptures has developed further over the last 20 years and is basically possible for 60-80% of patients. The treatment leads to success if the indications obtained by dynamic sonography are correctly interpreted (adaptation of the tendon ends up to 20 degrees plantar flexion), if the patient presents sufficient compliance and the physiotherapy is increasingly intensified depending on tendon healing. Modern ortheses allow an increased equinus position and therefore improved protection of the healing tendon. If these factors are present a relatively low re-rupture rate of only 7% can be achieved. The decisive advantage of conservative functional therapy is the avoidance of specific operative risks, such as infection and injury to the sural nerve. After removal of the orthesis the tendon should continue to be modeled using shoe insoles and raised heels.
在过去20年里,跟腱断裂的保守功能治疗有了进一步发展,基本上60%至80%的患者都适用。如果能正确解读动态超声检查得出的指征(肌腱断端在跖屈达20度时对合),患者有足够的依从性,并且根据肌腱愈合情况逐渐加强物理治疗,那么这种治疗就能取得成功。现代矫形器可使马蹄足姿势增加,从而更好地保护愈合中的肌腱。如果具备这些因素,就能实现相对较低的再断裂率,仅为7%。保守功能治疗的决定性优势在于避免了诸如感染和腓肠神经损伤等特定手术风险。去除矫形器后,应继续使用鞋垫和增高后跟来塑造肌腱。