Dhillon Mandeep S, Chauhan Devender, Kumar Vishal, Saini Uttam C
Dept of Orthopaedics, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Foot (Edinb). 2010 Dec;20(4):154-7. doi: 10.1016/j.foot.2010.09.008. Epub 2010 Oct 23.
Spontaneous bilateral idiopathic rupture of Achilles tendon is rare and usually results from sudden dorsiflexion of a plantar-flexed foot; the tendon is most often degenerated or diseased, and spontaneous bilateral rupture is not rare in patients suffering from chronic diseases. Management problems relate to reconstruction options and issues with early ambulation and weight bearing. We report a case of idiopathic bilateral Tendo-Achilles (TA) rupture with no obvious disease process, which was initially neglected, and subsequently reconstructed with LARS polyester ligament. The patient could be mobilized early despite bilateral involvement, but developed bilateral wound dehiscence which needed debridement and local flap coverage; aggressive rehabilitation finally leads to an excellent functional outcome. Despite the fact that artificial ligaments allow biointegration and can withstand stresses of early weight bearing, they often lead to wound related problems. Judicious use is advocated and good cases for their use maybe bilateral TA repair in neglected tears with gaps.
自发性双侧跟腱特发性断裂较为罕见，通常是由于跖屈的足部突然背屈所致；肌腱最常发生退变或病变，在患有慢性疾病的患者中自发性双侧断裂并不少见。治疗问题涉及重建方案以及早期活动和负重相关问题。我们报告一例无明显疾病过程的特发性双侧跟腱（TA）断裂病例，该病例最初被忽视，随后采用LARS聚酯韧带进行重建。尽管双侧受累，但患者仍能早期活动，但出现了双侧伤口裂开，需要清创和局部皮瓣覆盖；积极的康复治疗最终带来了极佳的功能结果。尽管人工韧带能够实现生物整合并能承受早期负重的压力，但它们常常导致与伤口相关的问题。提倡谨慎使用，其适用的良好病例可能是双侧TA修复被忽视的有间隙的撕裂伤。
