Revisión sobre el manejo no quirúrgico de la ruptura aguda del tendón de aquiles (tendón calcáneo) y planteamiento de un protocolo de tratamiento
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2019
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La ruptura aguda (<6 semanas) del tendón de Aquiles es una lesión con creciente incremento en la población adulta, especialmente entre la tercera y cuarta década de vida. Es el tendón que con más frecuencia sufre una ruptura en la extremidad inferior y estadísticamente corresponde al 20% de las rupturas de los tendones mayores. Su ocurrencia es principalmente en deportistas de actividades recreativas, con una frecuencia de 2-8 veces mayor en hombres que en mujeres y cada día más vistas en pacientes de mayor edad, dado el aumento en las expectativas de vida de la población en general y a la incorporación de estos en actividades físicas. Múltiples factores se han asociado a la ruptura del tendón de Aquiles, el uso crónico de esteroides y las infiltraciones con estos, uso de fluoroquinolonas, degeneración intrasustancia y pobre vascularidad del tendón, se han visto involucrados en la génesis de esta lesión6, sin embargo, aún no ha sido posible esclarecer completamente la razón por la cual un tendón en particular sufre de una ruptura bajo la misma carga mecánica en la que otros resisten bien ese peso de trabajo. Así como varía el comportamiento poblacional de la lesión, también ha venido cambiando su tratamiento, el cual, se puede dividir en manejo quirúrgico (abierto, percutáneo) y no quirúrgico con rehabilitación funcional temprana. Aún es controversial cuál es el mejor manejo para la población en general, sin embargo, en múltiples estudios, se ha demostrado tasas de reruptura e incorporación a la vida diaria similares con ambos grupos de tratamiento, con la ventaja estadística de una menor tasa de complicaciones para el manejo conservador. Es el objetivo de este trabajo realizar una revisión bibliográfica sobre la viabilidad del manejo conservador en el tratamiento de esta patología, analizar las posibles complicaciones y beneficios de este, demás de...
Inglés: Acute rupture (<6 weeks) of the Achilles tendon is a lesion with increasing presentation in the adult population, especially between the third and fourth decade of life. It is the tendon that most often suffers a rupture in the lower extremity and statistically corresponds to 20% of the ruptures of the major tendons. Its occurrence is mainly in athletes of recreational activities, with a frequency of 2-8 times greater in men than in women and every day more seen in older patients, given the increase in the life expectancy of the population in general and the incorporation of these people in physical activities. Multiple factors have been associated with rupture of the Achilles tendon, the chronic use of steroids and infiltrations with them, the use of fluoroquinolones, intrasubstance degeneration and poor vascularity of the tendon, have been involved in the genesis of this injury, however, it has not yet been possible to fully clarify the reason why a particular tendon suffers from a rupture under the same mechanical load in which others resist that work. As the population behavior of the lesion varies, its treatment has also changed, which can be divided into surgical (open, percutaneous) and non-surgical management with early functional rehabilitation. Although it is controversial which is the best management for the population in general, however, in multiple studies, similar rates of reruptura rates and incorporation to daily life have been demonstrated with both treatment groups, with the statistical advantage of a lower rate of complications. for conservative management. It is the objective of this work to carry out a bibliographic review on the viability of conservative treatment of this pathology, to analyze the possible complications and benefits of this, as well as to develop an evidence-based treatment protocol that is easily reproducible and that adapts to the national reality, in order...
Inglés: Acute rupture (<6 weeks) of the Achilles tendon is a lesion with increasing presentation in the adult population, especially between the third and fourth decade of life. It is the tendon that most often suffers a rupture in the lower extremity and statistically corresponds to 20% of the ruptures of the major tendons. Its occurrence is mainly in athletes of recreational activities, with a frequency of 2-8 times greater in men than in women and every day more seen in older patients, given the increase in the life expectancy of the population in general and the incorporation of these people in physical activities. Multiple factors have been associated with rupture of the Achilles tendon, the chronic use of steroids and infiltrations with them, the use of fluoroquinolones, intrasubstance degeneration and poor vascularity of the tendon, have been involved in the genesis of this injury, however, it has not yet been possible to fully clarify the reason why a particular tendon suffers from a rupture under the same mechanical load in which others resist that work. As the population behavior of the lesion varies, its treatment has also changed, which can be divided into surgical (open, percutaneous) and non-surgical management with early functional rehabilitation. Although it is controversial which is the best management for the population in general, however, in multiple studies, similar rates of reruptura rates and incorporation to daily life have been demonstrated with both treatment groups, with the statistical advantage of a lower rate of complications. for conservative management. It is the objective of this work to carry out a bibliographic review on the viability of conservative treatment of this pathology, to analyze the possible complications and benefits of this, as well as to develop an evidence-based treatment protocol that is easily reproducible and that adapts to the national reality, in order...
Descripción
Tesis (especialista en ortopedía y traumatología)--Universidad de Costa Rica. Sistema de Estudios de Posgrado, 2019
Palabras clave
CALCANEO - CIRUGIA, CALCANEO - FISIOLOGIA, CALCANEO - FRACTURAS - REHABILITACION, CALCANEO - FRACTURAS - TRATAMIENTO, PROTOCOLOS MEDICOS, TENDON DE AQUILES - ANATOMIA