Achilles tendon rupture may be the result of the joint action of these two mechanisms. In the area where blood vessels are scarce, repeated minor injuries delay the inflammatory repair process of tendon, and it will break when it is subjected to greater mechanical stress again.

① Morphology: Achilles tendon gradually narrows and thickens from top to bottom, which is the narrowest at 2 ~ 6 cm above calcaneal tubercle and the weakest here.

② Blood supply: Achilles tendon arteriography showed that the blood supply in the lower region was relatively small.

③ The number of Achilles tendon vessels decreases with age.

④ Long-term chronic traction strain: Achilles tendinitis and peritendonitis occur, and the achilles tendon tissue becomes brittle, which affects the blood supply of the achilles tendon?

⑤ Drugs: Quinolone antibiotics and cortisol hormone were used locally.

①Thompson squeezing test: in prone position, squeeze gastrocnemius muscle at the distal end of the maximum circumference of calf to observe whether there is plantarflexion in ankle joint. If there is no exercise, or the exercise is weak, the diagnosis can be made.

②Matles examination: Prone position actively bends the knee by 90 degrees, resulting in shortening of gastrocnemius muscle. Achilles tendon rupture may occur if the foot is in a neutral position or slightly extended backward. You can consult, but you can't decide.

③ Braein acupuncture examination: the needle was inserted percutaneously into the proximal achilles tendon to passively move the ankle joint. If the needle moves with it, the achilles tendon is continuous. Otherwise, it is considered bad.

④ Both ultrasound and MR are definite diagnosis and good examination methods.

Generally speaking, it is divided into: open, limited incision and minimally invasive percutaneous suture. The repair methods of acute achilles tendon rupture and chronic achilles tendon rupture are different and described separately.

① Conservative treatment is an option for all patients with acute achilles tendon rupture; That's all.

② Acute achilles tendon rupture can be repaired by fascia inversion, plantar muscle and fibula tendon reinforcement; However, there is evidence that the therapeutic effect is not better than simple "end-to-end" suture;

③ Relative contraindications:

Uncontrollable medical diseases (diabetes); Neuropathy; Poor skin and soft tissue conditions; Peripheral vascular diseases; The elderly (over 65 years old) and obese patients.

It is the "gold standard" of achilles tendon repair: low rate of re-breaking, high rate of recovery exercise and low incidence of complications, especially suitable for athletes.

Beautiful, less trauma; Complications: recurrent rupture (8%) and sural nerve injury (19%).

Mainly? Ma-griffiffth operation: local anesthesia can be used.

The steps are as follows:

1. After local anesthesia or spinal anesthesia or general anesthesia; Achilles tendon depression, proximal 2.5cm, with a small incision on both sides; Hemostatic forceps is used to separate skin, subcutaneous tissue and tendon sheath.

2. Puncture the No.0 nonabsorbable thread with a straight needle, and horizontally penetrate the tendon from the lateral incision to the medial incision;

3. After penetrating the achilles tendon with a straight needle, pierce the skin from the distal end of the broken end; Enlarge the puncture point with a blade.

4. Replace it with a curved needle, enter from the above exit point and pass out from half of the distal achilles tendon;

* * * * * At this time, the proximal suture should be tightened * * * *

5. After enlarging the puncture point, separate the subcutaneous and tendon sheath; Go back and leave this point;

6. After expanding the puncture point, puncture to the proximal end with a curved needle;

7. Tie a knot in the horseshoe position of the ankle joint;

The horseshoe position is: horseshoe icon, which should be plantar flexion.

The first 4 weeks: the plantar flexion was fixed at 20 degrees after operation; Unbearable weight;

The second 4 weeks: change to low-heeled horseshoe-shaped short leg plaster; Allowable load

The third 4 weeks: remove the plaster, do toe and standing exercises, and gradually return to the neutral position;

Fourth week: Continue to do 4 weeks of Achilles tendon stretching exercises.

Features:

1. After more than a week of Achilles tendon rupture, a large amount of fibrous tissue proliferated between the broken ends. If left untreated, it will cause the achilles tendon to lengthen and make it weak in the later high jump.

2. If the damage is within 3 months and the defect is less than 3cm after debridement, it can be directly repaired; This situation is rare;

3. More than 3 months, and the defect is more than 3cm, you need other technical reconstruction. For example, local tendon transposition (flexor pollicis longus, flexor digitorum longus, peroneal longus, plantar muscle) can bridge defects, strengthen tissues (V-Y plasty, gastrocnemius musculocutaneous inversion technique), synthetic materials or allogenic materials.