急性闭合性跟腱断裂的治疗进展-海南医学.PDFVIP

海南医学2015年12月第26卷第23期 doi:10.3969/j.issn.1003-6350.2015.23.1273 ·综 述· 急性闭合性跟腱断裂的治疗进展 杨华瑞，陈 园，樊 攀，鲍同柱 （三峡大学第一临床医学院宜昌市中心人民医院，湖北 宜昌 443002 ） 【摘要】 急性闭合性跟腱断裂临床发病率较高，多由剧烈运动引起。诊断主要依据病史、体格检查及影像 学检查。保守治疗容易发生再断裂且治疗周期长；手术治疗跟腱再断裂发生率低，但存在较多并发症风险。目 前已证实术后的早期康复锻炼能获得较好的修复效果；新兴的治疗手段具有一定优势及前景，但目前急性闭合 性跟腱断裂治疗尚无统一标准和策略。 【关键词】 跟腱断裂；急性；闭合；治疗；生物材料；细胞因子 【中图分类号】R686.1 【文献标识码】A 【文章编号】 1003—6350（2015 ）23—3520—04 AdvancesinthetreatmentofacuteclosedruptureofAchillestendon.YANG Hua-rui, CHEN Yuan, FAN Pan, BAO Tong-zhu. First School of Clinical Medicine, Three Gorges University and Central Peoples Hospital of Yichang, Yichang 443002, Hubei, CHINA 【Abstract】 The clinical incidence of acute closed rupture of Achilles tendon is fairly high, and it is mainly caused by strenuous exercise. The diagnosis are primarily based on medical history, physical examination and imaging studies. Conservative treatment tend to have a outcome of rerupture and long treatment cycle. Surgical treatment can reduce the incidence of rerupture, but there is more risk of complications. It has been proved that early postoperative rehabilitation exercises can get better effect of repairation. Newly emerging treatment has its advantages and pros- pects, but there is no unified standards and policies in the treatment of acute closed rupture of Achilles tendon. 【Keywords】Achilles tendon rupture; Acute; Closed; Treatment; Biological material; Cytokines 跟腱是人体最强大的肌腱，人在奔跑时，跟腱需 1.1 开放手术 开放手术包括断端直接缝合法 [1] 要承受约3 500 N 的拉力 ，其正常长度约15 cm，以 (Kessler、Krackow 、Bunnell 缝合法) 、Bosworth 法、 跟骨节结上2~6 cm 处最窄、血供最差，是最容易断裂 Lindholm 法、Abraham 倒“V-Y”腱成形术以及肌腱( 自 的部位(尤其以跟骨节结上3 cm 多见) 。急性闭合性 体、同种异体、人工肌腱