Collins Ruaraidh, Sudlow Alexis, Loizou Constantinos, Loveday David T, Smith George
Norfolk and Norwich University Hospital, Norwich, UK.
Norfolk and Norwich University Hospital, Norwich, UK.
Foot Ankle Surg. 2018 Apr;24(2):124-127. doi: 10.1016/j.fas.2016.12.006. Epub 2017 Jan 23.
The relative benefits of surgical and conservative treatment of Achilles tendon rupture are widely debated. With modern conservative management protocols, the re-rupture risk appears to fall to one similar to surgical repair with negligible loss of function. Conservative management typically employs a period of time in an equinus cast with sequential ankle dorsiflexion in a functional orthosis. The optimal duration of immobilisation and rate of dorsiflexion is unknown. We aimed to quantify the change in Achilles tendon approximation achieved in common immobilisation techniques to assist the design of rehabilitation protocols. Twelve fresh-frozen cadaveric specimens had 2.5cm of Achilles tendon excised. The gap between the tendon ends were measured via windowed full equinus casts and compared with functional boots with successively removed heel wedges. The greatest tendon apposition was achieved with the equinus cast. Each wedge removed decreased the reapproximation by approximately 5mm. This paper supports the early use of maximal equinus casting in early management of acute Achilles tendon ruptures.
跟腱断裂的手术治疗和保守治疗的相对益处存在广泛争议。采用现代保守治疗方案时，再断裂风险似乎降至与手术修复相近的水平，且功能丧失可忽略不计。保守治疗通常在使用马蹄形石膏固定一段时间后，再在功能性矫形器中逐步进行踝关节背屈。固定的最佳时长和背屈速率尚不清楚。我们旨在量化常见固定技术中跟腱接近程度的变化，以辅助康复方案的设计。十二个新鲜冷冻的尸体标本被切除了2.5厘米的跟腱。通过开窗的全马蹄形石膏测量肌腱两端之间的间隙，并与带有逐渐移除足跟楔形物的功能性靴子进行比较。马蹄形石膏实现了最大程度的肌腱对合。每移除一个楔形物，再对合程度大约降低5毫米。本文支持在急性跟腱断裂的早期治疗中尽早使用最大程度的马蹄形石膏固定。
