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首页> 外文期刊>Journal of Clinical Medicine >Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options
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Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options

机译：部分achilles肌腱破裂 - 被忽视的实体：关于诊断和治疗方案的叙事文献综述

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Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis and treatment options, and to give reference points for future research. There were few studies and sparse knowledge of scientific value, making it difficult to give evidence-based recommendations. Based on the few studies and the authors’ clinical experience, a diagnosis should be based on a patient’s history with a typical sharp onset of pain and inability to fully load the tendon. Previous intratendinous cortisone injections might be present. Clinical findings are a localized tender region in the tendon and often weakness during heel raises. Ultrasound and Doppler examinations show a region with an irregular and bulging superficial tendon line, often together with localized high blood flow. Magnetic resonance Imaging (MRI) shows a hyperintense signal in the tendon on T1 and T2-weighted sequences. First-line therapy should be a conservative approach using a 2 cm heel lift for the first 6 weeks and avoiding tendon stretching (for 12 weeks). This is followed by a reduced heel lift of 1 cm and progressive tendon loading at weeks 7–12. After 12 weeks, the heel lift can be removed if pain-free, and the patient can gradually start eccentric exercises lowering the heel below floor level and gradually returning to previous sport level. If conservative management has a poor effect, surgical exploration and the excision of the partial rupture and suturing is required. Augmentation procedures or anchor applications might be useful for partial ruptures in the Achilles insertion, but this depends on the size and exact location. After surgery, the 12 to 14-week rehabilitation program used in conservative management can be recommended before the patient’s return to full tendon loading activities.
机译：Achilles肌腱中的部分破裂是不常见的，并且通常被误解为加重的脑筋膜病变，并不总是被认为是鉴别诊断。该文献综述的目的是表征典型的症状，提供可用诊断和治疗方案的概述，并为未来的研究提供参考点。少数研究和对科学价值的稀疏了解，使得难以提供基于证据的建议。基于少数研究和作者的临床经验，诊断应基于患者的历史，典型的急剧发作，无法充分加载肌腱。可能存在先前的妥塞妥酮注射。临床调查结果是肌腱中的局部招标区，鞋跟升高期间的弱点。超声波和多普勒检查显示出具有不规则和凸出的浅肌腱线的区域，通常与局部高血流量一起。磁共振成像（MRI）显示T1和T2加权序列上的肌腱中的过敏信号。一线治疗应该是使用2厘米鞋跟升降机的保守方法，并避免肌腱拉伸（12周）。随后，在第7-12周的时间内，这是1厘米的鞋跟升降率1厘米，渐进肌腱载荷。 12周后，如果无痛，脚后跟可以拆除，患者可以逐渐开始偏心运动，将脚跟降低到楼层以下，并逐渐回到以前的运动水平。如果保守管理有差，外科勘探和部分破裂和缝合的切除是必需的。增强程序或锚申请可能对Achilles插入中的部分破裂有用，但这取决于大小和确切的位置。手术后，在患者恢复全腱载活动之前，可以建议在保守管理中使用的12至14周的康复计划。

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