Pagenstert G, Leumann A, Frigg A, Valderrabano V
Behandlungszentrum Bewegungsapparat, Orthopädische Universitätsklinik, Universitätsspital Basel, Spitalstraße 21, CH-4031 Basel, Schweiz.
Orthopade. 2010 Dec;39(12):1135-47. doi: 10.1007/s00132-010-1691-4.
Achilles tendon ruptures (ATR) are becoming the most frequent tendon rupture of the lower extremity, whereas less than 100 cases of tibialis anterior tendon ruptures (TATR) have been reported. Common in both tendons are the degenerative causes of ruptures in a susceptible tendon segment, whereas traumatic transections occur at each level. Triceps surae and tibialis anterior muscles are responsible for the main sagittal ankle range of motion and ruptures lead to a distinctive functional deficit. However, diagnosis is delayed in up to 25% of ATR and even more frequently in TATR. Early primary repair provides the best functional results. With progressive retraction and muscle atrophy delayed tendon reconstruction has less favourable functional results. But not all patients need full capacity, power and endurance of these muscles and non-surgical treatment should not be forgotten. Inactive patients with significant comorbidities and little disability should be informed that surgical treatment of TATR is complicated by high rates of rerupture and surgical treatment of ATR can result in wound healing problems rarely necessitating some kind of transplantation.
跟腱断裂(ATR)正成为下肢最常见的肌腱断裂,而胫骨前肌腱断裂(TATR)的报告病例不到100例。这两种肌腱断裂的常见原因是在易损肌腱节段出现退行性变,而创伤性横断则发生在各个层面。小腿三头肌和胫骨前肌负责踝关节主要的矢状面活动范围,其断裂会导致明显的功能缺陷。然而,高达25%的ATR患者诊断会延迟,TATR患者诊断延迟的情况甚至更常见。早期一期修复能提供最佳的功能结果。随着肌腱逐渐回缩和肌肉萎缩,延迟肌腱重建的功能结果较差。但并非所有患者都需要这些肌肉具备全部的能力、力量和耐力,非手术治疗也不应被忽视。对于患有严重合并症且活动少、残疾程度低的患者,应告知他们TATR手术治疗的再断裂发生率高,而ATR手术治疗可能导致伤口愈合问题,很少需要某种移植。