Dept of Orthopaedic Surgery, Dunedin Hospital, Private Bag, Dunedin, New Zealand.
Foot Ankle Int. 2011 Apr;32(4):337-43. doi: 10.3113/FAI.2011.0337.
This study reports on the demographics of acute Achilles tendon rupture in our region and compares the results of a selective approach to operative and nonoperative treatment using an identical rehabilitation program with functional bracing.
A consecutive series of 363 patients, aged 15 to 60 years, treated over 8.5 years by either open operative repair (143) or nonoperatively (220) were compared with respect to demographics, re-rupture rate, and major wound complication.
There was an almost equal number of males (159) and females (152) up to age 50 years but males comprised 73% of patients aged 51 to 60 years. Netball was the most common cause of injury and explains the relatively high incidence in females. In the 143 patients treated surgically there were two re-ruptures (1.4%) and two reoperations for wound complications (1.4%). In the 220 patients treated nonoperatively there were 19 re-ruptures (8.6%), 13 of 113 males (11.5%) and six of 107 females (5.6%). There was a significantly lower re-rupture rate, and reoperation rate in the surgical group (p < 0.05). In the nonoperative group there was a significantly lower rate of re-rupture in patients over 40 (six of 119) (4.1%) compared with those 40 years and under (13 of 99, 13.1%) and between females over 40 when compared with males 40 years and under.
In our region there is a high incidence of Achilles tendon rupture among women due to netball and results in a younger age of injury than previously reported. Our results support surgery in patients less than 40 years, particularly males, if there are no contraindications. Functional bracing as part of nonoperative treatment can result in low re-rupture rates in patients over 40, especially in females.
本研究报告了我们地区急性跟腱断裂的人口统计学数据，并比较了采用相同康复计划和功能支具的选择性手术和非手术治疗的结果。
连续 363 例年龄在 15 至 60 岁的患者，在 8.5 年以上的时间里分别接受了开放性手术修复（143 例）或非手术治疗（220 例），对其人口统计学资料、再断裂率和主要伤口并发症进行了比较。
在 50 岁以下的患者中，男女比例几乎相等（男性 159 例，女性 152 例），但在 51 至 60 岁的患者中，男性占 73%。无挡板篮球是受伤的最常见原因，这也解释了女性发病率较高的原因。在 143 例手术治疗的患者中，有 2 例再断裂（1.4%）和 2 例伤口并发症再手术（1.4%）。在 220 例非手术治疗的患者中，有 19 例再断裂（8.6%），113 例男性中有 13 例（11.5%），107 例女性中有 6 例（5.6%）。手术组的再断裂率和再手术率明显较低（p < 0.05）。在非手术组中，40 岁以上患者（6 例，119 例，4.1%）的再断裂率明显低于 40 岁以下患者（13 例，99 例，13.1%），40 岁以上女性与 40 岁以下男性相比，再断裂率也较低。
在我们地区，由于无挡板篮球，女性跟腱断裂的发病率较高，受伤年龄也比以前报道的年轻。我们的结果支持在没有禁忌症的情况下，对 40 岁以下的患者，特别是男性患者进行手术治疗。作为非手术治疗的一部分，功能支具可使 40 岁以上患者，特别是女性患者的再断裂率降低。
