急性闭合性跟腱断裂非手术治疗的研究进展

Research Advances in Nonoperative Treatment of Acute Closed Achilles Tendon Rupture

摘要: 跟腱作为人体最强健的肌腱，跟腱在运动功能中承担着核心力学负荷，却因其独特的解剖特性成为高发断裂部位。尽管其损伤机制尚未完全阐明，但现有证据支持“暴力牵拉–退行性变–累积微损伤”三联作用假说。近年来，全球范围内跟腱断裂发病率持续攀升，但其最佳治疗策略仍存争议。传统观念(2005年前)因非手术治疗再断裂率较高及康复周期漫长，多推荐手术修复以降低再断裂风险。然而，随着早期功能康复体系的革新，现代保守治疗通过动态支具联合渐进性负重训练，将再断裂率显著下降，且治疗后1年的总跟腱断裂评分与手术组无统计学差异(P > 0.05)。同时，手术相关并发症风险促使临床决策向非手术方案倾斜，尤其适用于老年患者或合并代谢性疾病人群。本综述系统梳理非手术治疗的最新循证证据，旨在为临床医生优化治疗方案提供科学依据。

Abstract: The Achilles tendon, the strongest tendon in the human body, plays a central biomechanical role in locomotion but is prone to rupture due to its unique anatomical characteristics. Although its injury mechanisms remain incompletely understood, existing evidence supports the triple mechanism hypothesis of “violent traction-degenerative changes-cumulative microtrauma”. Despite the rising global incidence of Achilles tendon ruptures in recent years, the optimal treatment strategy remains controversial. The traditional paradigm (before 2005) favored surgical repair to mitigate re-rupture risks associated with higher re-rupture rates and prolonged recovery in nonoperative approaches. However, with the innovation in early functional rehabilitation protocols, modern conservative treatment with dynamic bracing combined with progressive weight-bearing training has significantly reduced re-rupture rates. At 1-year follow-up, nonoperative treatment demonstrates no significant difference in the Achilles tendon total rupture score compared to operative groups (P > 0.05). Furthermore, surgical complication risks have prompted clinical decision-making toward nonoperative strategies, especially for elderly patients or those with metabolic comorbidities. This review synthesizes the latest evidence on nonoperative management to provide clinicians with evidence-based insights for optimizing therapeutic decision-making.