Lui Tun Hing
Consultant, Department of Orthopaedics and Traumatology, North District Hospital, New Territories, Hong Kong Special Administrative Region, Sheung Shui, People's Republic of China.
J Foot Ankle Surg. 2014 Nov-Dec;53(6):806-9. doi: 10.1053/j.jfas.2014.06.026. Epub 2014 Aug 14.
About 10% to 25% of acute ruptures of the Achilles tendon go undiagnosed for some time beyond what would be optimal for repair and a return to optimal function. Managing these chronic or neglected ruptures is a surgical challenge, because the tendon ends retract and atrophy and could develop a short, fibrous distal stump. In the present report, a patient with a ruptured right Achilles tendon, neglected for approximately 10 years, is described. The chronically injured tendon was successfully treated by overwrapping the interposed scar at the rupture site. This minimally invasive technique restored tension to the tendon, a prerequisite for which was the presence of functional triceps surae, confirmed by identification of gross contraction of the muscle during tiptoeing. The procedure is contraindicated when the scar tissue is not intact and does not have sufficient laxity to allow adequate dorsiflexion of the ankle after overwrapping the tendon or when the triceps surae are nonfunctional.
约10%至25%的跟腱急性断裂在超过最佳修复及恢复最佳功能的时间后仍未得到诊断。处理这些慢性或被忽视的断裂是一项手术挑战,因为肌腱断端会回缩和萎缩,并可能形成短而纤维化的远端残端。在本报告中,描述了一名右侧跟腱断裂且被忽视约10年的患者。通过包裹破裂部位的中间瘢痕成功治疗了慢性损伤的肌腱。这种微创技术恢复了肌腱的张力,其前提条件是存在功能性的小腿三头肌,踮脚尖时肌肉的明显收缩证实了这一点。当瘢痕组织不完整且没有足够的松弛度以在包裹肌腱后使踝关节充分背屈时,或当小腿三头肌无功能时,该手术为禁忌。