急性跟腱断裂处理的几点争议

Several controversies on the management of acute Achilles tendon rupture

跟腱断裂是足踝部最常见的肌腱损伤,发病率呈逐年增高趋势。近年来,无论保守治疗或手术方式均取得了较好的临床效果。2015年国内已发布针对急性跟腱断裂的临床诊疗指南,并于2022年进行了更新。本文对急性跟腱断裂修复的相关解剖与临床问题进行讨论:跟腱旋转下行纤维和浅筋膜,内侧伴行的跖肌腱,Kager脂肪垫和跟腱弯屈机制,手术时机和断端间瘢痕组织等。

Achilles tendon(AT)rupture is the most common tendon injury in the foot and ankle.The incidence rate is gradually increasing.In recent years,some researches on the conservative treatment and surgery treatment of AT rupture have been reported to achieve excellent clinical results.The Evidence-based Clinical Diagnosis and Treatment Guide for the diagnosis and treatment of acute AT rupture has been published in 2015,and updated in 2022.This paper discussed the anatomical characteristics and controversial issues relative to clinical treatment of AT rupture,including the descending twisted Achilles tendinous fibers,superficial aponeurosis cruris,medially concomitant plantaris tendon,Kager's fat pad,Achilles tendon bending mechanism,the timing of surgery for AT rupture and scar tissue located between the tendon stumps.