急性跟腱斷裂治療的研究進展_《中國修復重建外科雜志》

作者：

姜楠 , 相大勇 , 余斌

南方醫科大學南方醫院創傷骨科（廣州，510515）;

關鍵詞：

急性跟腱斷裂保守治療開放手術經皮微創手術

DOI：

10.7507/1002-1892.20130138

視頻：

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目的總結急性跟腱斷裂治療的研究進展。方法查閱近年關于急性跟腱斷裂治療的相關文獻，進行總結分析。結果急性跟腱斷裂治療包括手術及保守治療兩種方式。手術治療包括開放和經皮微創兩種術式，術后跟腱再斷裂發生率低，但存在較高的傷口感染及神經損傷等并發癥風險。保守治療后進行早期功能鍛煉能減少跟腱再斷裂發生率，但尚無統一的矯形支具和鍛煉方法。結論手術與保守治療急性跟腱斷裂各有利弊，對功能恢復方面的評價尚無定論，下一步需對保守治療后早期功能鍛煉策略及其促進跟腱愈合的相關機制進行探索。

引用本文： 姜楠,相大勇,余斌. 急性跟腱斷裂治療的研究進展. 中國修復重建外科雜志, 2013, 27(5): 628-632. doi: 10.7507/1002-1892.20130138 復制

1.	Nyyssönen T, Lüthje P, Kröger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg, 2008, 97(3): 272-275.
2.	Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med, 1999, 9(3): 157-160.
3.	Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome. J Bone Joint Surg (Br), 2011, 93(8): 1071-1078.
4.	Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
5.	Nistor L. Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg (Am), 1981, 63(3): 394-399.
6.	Gwynne-Jones DP, Sims M, Handcock D. Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol. Foot Ankle Int, 2011, 32(4): 337-343.
7.	Suchak AA, Bostick G, Reid D, et al. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int, 2005, 26(11): 932-936.
8.	Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle, 1985, 6(1): 34-38.
9.	Maffulli N. Achilles tendon rupture. Br J Sports Med, 1995, 29(4): 279-280.
10.	Williams JG. Achilles tendon lesions in sport. Sports Med, 1993, 16(3): 216-220.
11.	McQuillan R, Gregan P. Tendon rupture as a complication of corticosteroid therapy. Palliat Med, 2005, 19(4): 352-353.
12.	Seeger JD, West WA, Fife D, et al. Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population. Pharmacoepidemiol Drug Sa, 2006, 15(11): 784-792.
13.	Wilson AM, Goodship AE. Exercise-induced hyperthermia as a possible mechanism for tendon degeneration. J Biomech, 1994, 27(7): 899-905.
14.	Birch HL, Wilson AM, Goodship AE. The effect of exercise-induced localised hyperthermia on tendon cell survival. J Exp Biol, 1997, 200(Pt 11): 1703-1708.
15.	Arner O, Lindholm A. Subcutaneous rupture of the Achilles tendon; a study of 92 cases. Acta Chir Scand Suppl, 1959, 116(Supp 239): 1-51.
16.	王亦璁. 骨與關節損傷. 北京: 人民衛生出版社, 2007: 1491.
17.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 3版. 北京: 人民軍醫出版社, 2005: 816.
18.	Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res, 1977, (128): 247-255.
19.	Gigante A, Moschini A, Verdenelli A, et al. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc, 2008, 16(2): 204-209.
20.	Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int, 2001, 22(7): 559-568.
21.	Henríquez H, Muñoz R, Carcuro G, et al. Is percutaneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res, 2012, 470(4): 998-1003.
22.	Maffulli N, Longo UG, Ronga M, et al. Favorable outcome of percutaneous repair of achilles tendon ruptures in the elderly. Clin Orthop Relat Res, 2010, 468(4): 1039-1046.
23.	Chan AP, Chan YY, Fong DT, et al. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol, 2011, 3(1): 32.
24.	Majewski M, Rohrbach M, Czaja S, et al. Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med, 2006, 34(5): 793-798.
25.	Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med, 2005, 33(9): 1369-1379.
26.	McMahon SE, Smith TO, Hing CB. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg, 2011, 17(4): 211-217.
27.	Khan RJ, Fick D, Brammar TJ, et al. Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2004, (3): CD003674.
28.	Möller M, Movin T, Granhed H, et al. Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg (Br), 2001, 83(6): 843-848.
29.	Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg (Br), 2011, 93(10): 1362-1366.
30.	Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial. Am J Sports Med, 2008, 36(9): 1688-1694.
31.	Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg (Am), 2010, 92(17): 2767-2775.
32.	Garrick JG. Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute achilles tendon ruptures? Clin J Sport Med, 2012, 22(4): 379-380.
33.	Karkhanis S, Mumtaz H, Kurdy N. Functional management of Achilles tendon rupture: A viable option for non-operative management. Foot Ankle Surg, 2010, 16(2): 81-86.
34.	Costa ML, Macmillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
35.	Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med, 2010, 38(11): 2186-2193.
36.	Bhandari M, Guyatt GH, Siddiqui F, et al. Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res, 2002, (400): 190-200.
37.	Khan RJ, Carey Smith R. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2010, (9): CD003674.
38.	Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop, 2012, 36(4): 765-773.
39.	Zhao HM, Yu GR, Yang YF, et al. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis. Chin Med J (Engl), 2011, 124(23): 4050-4055.
40.	Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg (Am), 2010, 92(14): 2466-2468.
41.	Kearney RS, Costa ML. Current concepts in the rehabilitation of an acute rupture of the tendo Achillis. J Bone Joint Surg (Br), 2012, 94(1): 28-31.

1. Nyyssönen T, Lüthje P, Kröger H. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg, 2008, 97(3): 272-275.
2. Maffulli N, Waterston SW, Squair J, et al. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med, 1999, 9(3): 157-160.
3. Keating JF, Will EM. Operative versus non-operative treatment of acute rupture of tendo Achillis: a prospective randomised evaluation of functional outcome. J Bone Joint Surg (Br), 2011, 93(8): 1071-1078.
4. Cetti R, Christensen SE, Ejsted R, et al. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med, 1993, 21(6): 791-799.
5. Nistor L. Surgical and non-surgical treatment of Achilles Tendon rupture. A prospective randomized study. J Bone Joint Surg (Am), 1981, 63(3): 394-399.
6. Gwynne-Jones DP, Sims M, Handcock D. Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol. Foot Ankle Int, 2011, 32(4): 337-343.
7. Suchak AA, Bostick G, Reid D, et al. The incidence of Achilles tendon ruptures in Edmonton, Canada. Foot Ankle Int, 2005, 26(11): 932-936.
8. Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle, 1985, 6(1): 34-38.
9. Maffulli N. Achilles tendon rupture. Br J Sports Med, 1995, 29(4): 279-280.
10. Williams JG. Achilles tendon lesions in sport. Sports Med, 1993, 16(3): 216-220.
11. McQuillan R, Gregan P. Tendon rupture as a complication of corticosteroid therapy. Palliat Med, 2005, 19(4): 352-353.
12. Seeger JD, West WA, Fife D, et al. Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population. Pharmacoepidemiol Drug Sa, 2006, 15(11): 784-792.
13. Wilson AM, Goodship AE. Exercise-induced hyperthermia as a possible mechanism for tendon degeneration. J Biomech, 1994, 27(7): 899-905.
14. Birch HL, Wilson AM, Goodship AE. The effect of exercise-induced localised hyperthermia on tendon cell survival. J Exp Biol, 1997, 200(Pt 11): 1703-1708.
15. Arner O, Lindholm A. Subcutaneous rupture of the Achilles tendon; a study of 92 cases. Acta Chir Scand Suppl, 1959, 116(Supp 239): 1-51.
16. 王亦璁. 骨與關節損傷. 北京: 人民衛生出版社, 2007: 1491.
17. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 3版. 北京: 人民軍醫出版社, 2005: 816.
18. Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res, 1977, (128): 247-255.
19. Gigante A, Moschini A, Verdenelli A, et al. Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc, 2008, 16(2): 204-209.
20. Lim J, Dalal R, Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int, 2001, 22(7): 559-568.
21. Henríquez H, Muñoz R, Carcuro G, et al. Is percutaneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res, 2012, 470(4): 998-1003.
22. Maffulli N, Longo UG, Ronga M, et al. Favorable outcome of percutaneous repair of achilles tendon ruptures in the elderly. Clin Orthop Relat Res, 2010, 468(4): 1039-1046.
23. Chan AP, Chan YY, Fong DT, et al. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol, 2011, 3(1): 32.
24. Majewski M, Rohrbach M, Czaja S, et al. Avoiding sural nerve injuries during percutaneous Achilles tendon repair. Am J Sports Med, 2006, 34(5): 793-798.
25. Cretnik A, Kosanovic M, Smrkolj V. Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study. Am J Sports Med, 2005, 33(9): 1369-1379.
26. McMahon SE, Smith TO, Hing CB. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg, 2011, 17(4): 211-217.
27. Khan RJ, Fick D, Brammar TJ, et al. Interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2004, (3): CD003674.
28. Möller M, Movin T, Granhed H, et al. Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg (Br), 2001, 83(6): 843-848.
29. Wallace RG, Heyes GJ, Michael AL. The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg (Br), 2011, 93(10): 1362-1366.
30. Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial. Am J Sports Med, 2008, 36(9): 1688-1694.
31. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg (Am), 2010, 92(17): 2767-2775.
32. Garrick JG. Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute achilles tendon ruptures? Clin J Sport Med, 2012, 22(4): 379-380.
33. Karkhanis S, Mumtaz H, Kurdy N. Functional management of Achilles tendon rupture: A viable option for non-operative management. Foot Ankle Surg, 2010, 16(2): 81-86.
34. Costa ML, Macmillan K, Halliday D, et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg (Br), 2006, 88(1): 69-77.
35. Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med, 2010, 38(11): 2186-2193.
36. Bhandari M, Guyatt GH, Siddiqui F, et al. Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res, 2002, (400): 190-200.
37. Khan RJ, Carey Smith R. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev, 2010, (9): CD003674.
38. Jiang N, Wang B, Chen A, et al. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. Int Orthop, 2012, 36(4): 765-773.
39. Zhao HM, Yu GR, Yang YF, et al. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis. Chin Med J (Engl), 2011, 124(23): 4050-4055.
40. Chiodo CP, Glazebrook M, Bluman EM, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on treatment of Achilles tendon rupture. J Bone Joint Surg (Am), 2010, 92(14): 2466-2468.
41. Kearney RS, Costa ML. Current concepts in the rehabilitation of an acute rupture of the tendo Achillis. J Bone Joint Surg (Br), 2012, 94(1): 28-31.

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《中國修復重建外科雜志》

急性跟腱斷裂治療的研究進展

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