急性跟腱断裂治疗方式的临床进展

Clinical Advances in the Treatment of Acute Achilles Tendon Rupture

摘要: 近年来，急性跟腱断裂(Acute Achilles Tendon Rupture, AATR)的发病率呈上升趋势，其最优治疗路径的选择仍是足踝外科领域争议的焦点。流行病学研究显示，运动损伤是其主要致病因素，而退变性改变与生物力学超负荷的共同作用构成了核心致病机制。传统观点认为手术治疗可降低再断裂风险，但现代康复理念的引入使非手术治疗展现出竞争性优势。最新Meta分析表明，在接受早期功能锻炼的前提下，非手术治疗与手术修复在跟腱断裂评分(Achilles Tendon Total Rupture Score, ATRS)及再断裂率上已无显著统计学差异，且规避了切口并发症的风险。针对手术干预，微创手术(Minimally Invasive Surgery, MIS)正逐渐取代传统开放手术。临床实证显示，微创修复在显著缩短手术时间的同时，可降低切口感染风险，且术后瘢痕满意度更高，但也增加了腓肠神经损伤风险。此外，组织工程与再生医学的介入为腱骨愈合提供了新思路。未来研究可以聚焦于干细胞外泌体等精准生物制剂的临床转化，并结合生物力学反馈优化个体化康复方案。

Abstract: The incidence of acute Achilles tendon rupture (AATR) has shown an upward trend in recent years, and the selection of the optimal treatment pathway remains a focal point of debate in the field of foot and ankle surgery. Epidemiological studies indicate that sports injuries are the primary causative factor, while the combined effects of degenerative changes and biomechanical overload constitute the core pathogenic mechanism. Traditional views suggest that surgical intervention can reduce the risk of re-rupture, but the introduction of modern rehabilitation concepts has demonstrated the competitive advantages of non-surgical treatments. The latest meta-analysis shows that, with early functional exercise, there is no significant statistical difference between non-surgical treatment and surgical repair in terms of achilles tendon total rupture score (ATRS) and re-rupture rate, while avoiding the risk of incision complications. Regarding surgical interventions, minimally invasive surgery (MIS) is gradually replacing traditional open surgery. Clinical evidence demonstrates that MIS not only significantly reduces operative time but also lowers the risk of incision infection and improves postoperative scar satisfaction, albeit at the cost of increased peroneal nerve injury risk. Additionally, the integration of tissue engineering and regenerative medicine has provided new insights into tendon-bone healing. Future research may focus on the clinical translation of precision biologics such as stem cell exosomes and the optimization of individualized rehabilitation plans through biomechanical feedback.