Mandelbaum B R, Myerson M S, Forster R
Santa Monica Orthopaedic and Sports Medicine Group, CA 90404, USA.
Am J Sports Med. 1995 Jul-Aug;23(4):392-5. doi: 10.1177/036354659502300403.
We prospectively treated 29 athletes who had Achilles tendon ruptures according to a functional rehabilitation protocol. The 25 male and 4 female patients had a mean age of 35 years (range, 19 to 56). The repair was performed with a Krackow suture of No. 2 nonabsorbable polyfilament. Patients began range-of-motion exercises 72 hours after surgery, used a posterior splint for 2 weeks, and then began ambulation in a hinged orthosis. Six weeks after surgery, use of the orthosis was discontinued, full weightbearing was allowed, and progressive resistance exercises were initiated. Isokinetic strength and endurance testing were performed at 3, 6, and 12 months after surgery. There were no reruptures. Two patients developed superficial wound infections that responded to debridement or local wound care. One patient suffered a pulmonary embolism. At 3 months' followup, isokinetic testing showed the mean functional deficits were 36% and 35% of the opposite leg at 60 and 120 deg/sec, respectively. By 6 months, the mean deficits were 2.9% and 2.3% at 60 and 120 deg/sec, respectively. All patients returned to preinjury activity levels at a mean of 4 months (range, 3 to 7) after repair. By 12 months, there were no significant differences in ankle motion, isokinetic strength, or endurance as compared with the uninvolved side.
我们根据功能康复方案对29例跟腱断裂的运动员进行了前瞻性治疗。25例男性和4例女性患者的平均年龄为35岁（范围19至56岁）。采用2号不可吸收多股丝线的Krackow缝合法进行修复。患者术后72小时开始进行关节活动度练习，使用后侧夹板2周，然后开始在带铰链的矫形器中行走。术后6周，停止使用矫形器，允许完全负重，并开始进行渐进性抗阻练习。在术后3个月、6个月和12个月进行等速肌力和耐力测试。没有再断裂发生。2例患者发生浅表伤口感染，经清创或局部伤口护理后好转。1例患者发生肺栓塞。在3个月的随访中，等速测试显示，在60°/秒和120°/秒时，平均功能缺陷分别为对侧腿的36%和35%。到6个月时，在60°/秒和120°/秒时，平均缺陷分别为2.9%和2.3%。所有患者在修复后平均4个月（范围3至7个月）恢复到伤前的活动水平。到12个月时，与未受伤侧相比，踝关节活动度、等速肌力或耐力均无显著差异。
