Division of Orthopaedic Surgery, Leicester General Hospital, Leicester, United Kingdom.
J Bone Joint Surg Am. 2011 Dec 21;93(24):2265-70. doi: 10.2106/JBJS.J.01757.
Previous reports have suggested that knee flexion improves tendon edge apposition following acute rupture of the Achilles tendon. The aim of the present study was to determine, with use of ultrasonography, the effects of knee and ankle position on the Achilles tendon gap distance in patients with an acute rupture.
Twenty-six patients with a unilateral acute complete Achilles tendon rupture that had been confirmed with ultrasonography were recruited within a week after the injury. The mean age at the time of presentation was forty-one years. Ultrasound measurements included the location of the rupture and the gap distance between the superficial tendon edges with the ankle in neutral and the knee extended. The gap distance was sequentially measured with the foot in maximum equinus at the ankle and with 0°, 30°, 60°, and 90° of knee flexion.
The mean distance of the rupture from the calcaneal enthesis was 52 mm (range, 40 to 76 mm). The mean gap distance with the ankle in neutral and the knee extended was 12 mm (95% confidence interval, 10 to 13 mm). This distance decreased to 5 mm (95% confidence interval, 4 to 7 mm) when the foot was placed in maximum ankle equinus with 0° of knee flexion and to 4 mm (95% confidence interval, 3 to 5 mm) with 30° of knee flexion, 3 mm (95% confidence interval, 2 to 4 mm) with 60° of knee flexion, and 2 mm (95% confidence interval, 1 to 2 mm) with 90° of knee flexion. Expressing the reduction in gap distance with each successive position as a percentage of the gap distance with the knee extended and the ankle in neutral revealed a mean reduction of 55.7%, 64.4%, 75.4%, and 84.8% with maximum ankle equinus and 0°, 30°, 60°, and 90° of knee flexion, respectively. The difference in gap distance between each of these positions was significant (p < 0.05).
Maximum ankle equinus alone significantly reduces the gap distance after acute Achilles tendon rupture. Increasing knee flexion further reduces the gap distance by small increments that, although significant, may not be clinically important.
既往研究表明，膝关节屈曲可改善跟腱急性断裂后腱边缘贴合。本研究旨在通过超声检查确定膝关节和踝关节位置对急性跟腱断裂患者跟腱间隙的影响。
在受伤后一周内，共招募了 26 例单侧急性完全跟腱断裂的患者。就诊时的平均年龄为 41 岁。超声测量包括断裂部位和浅层腱边缘之间的间隙，踝关节中立位和膝关节伸展位。依次测量踝关节最大跖屈位和膝关节 0°、30°、60°和 90°屈曲位时的间隙距离。
距跟腱止点的平均断裂距离为 52mm（范围，4076mm）。踝关节中立位、膝关节伸展位时的平均间隙距离为 12mm（95%置信区间，1013mm）。当足处于最大跖屈位且膝关节屈曲 0°时，间隙距离减小至 5mm（95%置信区间，47mm），当膝关节屈曲 30°时减小至 4mm（95%置信区间，35mm），当膝关节屈曲 60°时减小至 3mm（95%置信区间，24mm），当膝关节屈曲 90°时减小至 2mm（95%置信区间，12mm）。将每个连续位置的间隙距离减小量表示为膝关节伸展和踝关节中立位时的间隙距离的百分比，结果显示，最大跖屈位和膝关节 0°、30°、60°和 90°时的平均间隙距离分别减少了 55.7%、64.4%、75.4%和 84.8%。这些位置之间的间隙距离差异均有统计学意义（p<0.05）。
单独最大踝关节跖屈可显著减小急性跟腱断裂后的间隙距离。进一步增加膝关节屈曲可使间隙距离进一步减小，但增加幅度较小，尽管有统计学意义，但可能无临床意义。
