| Abstract | Ahilova tetiva je najjača i najdeblja tetiva u ljudskom tijelu . Ahilova tetiva je prokrvljena preko dvije arterije, stražnje tibijalne i peronealne arterije, a inervirana je od strane senzornih živaca suralnog živca te živca cutaneusa. Kao mnoge druge tetive , Ahilova tetiva nema pravu tetivnu ovojnicu. Umjesto toga je okružena paratenonom sastavljenim od mekog tkiva. Opterećenje koje izazove istezanje veće od 8-10 % duljine Ahilove tetive prouzrokuje njenu kompletnu rupturu. Ruptura Ahilove tetive je češća u muškaraca, s muško-ženskim omjerom 7:1 do 12:1. Ruptura Ahilove tetive na lijevoj strani je češća nego na desnoj vjerojatno zbog veće prevalencije individua kojima je desna strana dominantna te se opiru sa lijevim donjim dijelom, udom. Tipično, akutna ruptura Ahilove tetive se pojavljuje kod muškaraca koji su u dobi od 30 do 40 godina, koji se bave uredskim poslovima te se povremeno bave sportom. Istovremena bilateralna ruptura Ahilove tetive je veoma rijetka kod zdravih pojedinaca, dok se može pojaviti kod starijih ljudi koji pate od neke bolesti te već duže vrijeme primaju steroidne lijekove. Točni uzroci rupture Ahilove tetive su još nejasni , ali je literatura puna teorija, uključujući ponavljane mikrotraume, poremećaj inhibitora mehanizma, povezanost rupture sa krvnom grupom nula, hipoksiju, degeneraciju tetive, smanjenu perfuziju koja rezultira degenerativnim promjenama te sistemna ili lokalna upotreba steroida. Ahilova tetiva je veoma često zahvaćena sindromom prenaprezanja, a ovisno o lokalizaciji upalnih promjena, riječ je o miotendinitisu, tendinitisu, paratenonitisu ili entenzitisu. Ruptura Ahilove tetive je karakteristična za zadnji stadij sindroma prenaprezanja. Klinički znakovi su :izrazito opipljiva udubina pri dorzalnoj fleksiji stopala odmah nakon ozljede, te tu udubinu vrlo brzo ispunjava oteklina i podljev krvi, hematom, jaka bol na pritisak, te pozitivan Thomsonov test. Većina tehnika i procedura koje su opisane kod liječenja akutne rupture Ahilove tetive mogu se podijeliti u 3 grupe : otvorena operacija, perkutana operacija i konzervativno liječenje. Osnovni zadatak rehabilitacije svakako je povratak pune fleksibilnosti, već tada zadebljane i krute tetive. Drugi je zadatak snaženje oslabljenih mišića potkoljenice, kao i povratak refleksnog odgovora tetive kroz proprioceptivne vježbe. Posebnu pažnju treba obratiti na gležanj i male zglobove stopala koji mogu biti uzrok boli nakon skidanja gipsa. Pomoć fizioterapeuta ubrzava proces rehabilitacije te sprječava mogućnost ponovnog ozljeđivanja davajući pravilne savjete. |
| Abstract (english) | The Achilles tendon is the strongest and thickest tendon in human body. The Achilles tendon is vascularized through two arteries, tibial posterior and peroneal arteries, and innervated by the sensory nerves by the sural nerve and nerve cutaneus. Like many other tendons, Achilles tendon doesn't have real tendon sheath. Instead it is surrounded by paratenon composed of soft tissue. Load that cause stretching greater than 8-10% of the length of the Achilles tendon cause its complete rupture. Achilles tendon rupture is more common in males, with a male-female ratio of 7: 1 to 12:1. Achilles tendon Rupture of the n on the left side is more common than on the right side,probably due to the greater prevalence of individuals where the right side is dominant and resist with the left lower part,extremity. Typically, acute Achilles tendon rupture occurs in men who are 30 to 40 years old, dealing with office jobs and occasionally sports. Simultaneous bilateral rupture of the Achilles tendon is rare in healthy individuals, as can occur in older people who suffer from a disease that has long received steroid medication. The exact causes of Achilles tendon rupture are still unclear, but the literature is full of theories, including repetitive microtrauma, disorder inhibitor mechanism, the link rupture with blood group zero, hypoxia, tendon degeneration, reduced perfusion resulting in deterioration of the systemic or topical use of steroids. The Achilles tendon is often affected by overuse injuries, depending on the localization of inflammatory changes, it is a miotendinitis, tendinitis, paratenonitis or entenzitis. Rupture of the Achilles tendon is characteristic of the last stage of overuse injuries. Clinical signs include: a very tangible dent in the dorsal flexion of the foot immediately after the injury, and the hollow very quickly fills the swelling and bruise, hematoma, severe pain on pressure, and a positive Thompson test. Most of the techniques and procedures described in the treatment of acute rupture of the Achilles tendon can be divided into 3 groups: open surgery, percutaneous surgery and conservative treatment. The main task of rehabilitation certainly return full flexibility, but then thickened and stiff tendons. Another task is strengthening the weakened muscles of lower leg as well as the return of the tendon reflex responses through proprioceptive exercises. Particular attention should be given to the ankle and small joints of the foot, which may be the cause of pain after removal of plaster.Physiotherapist help accelerate the rehabilitation process and prevents the possibility of re-injury by giving proper advices. |
