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JBJS:急性跟腱断裂 行保守治疗亦有效

2012-12-21 JBJS CMT 程蓓 编译

跟腱保守治疗
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　　美国和加拿大一项荟萃分析显示，采用功能康复方案的医学中心应考虑对急性跟腱断裂者采用保守治疗。保守治疗与手术治疗者的跟腱再次断裂率相似，且有利于减少其他并发症。对于不采用早期功能锻炼方案的中心，可选择手术治疗以降低患者跟腱再断裂的风险。论文12月5日发表于《骨与关节外科杂志（美国卷）》[J Bone Joint Surg Am 2012，94（2

　　美国和加拿大一项荟萃分析显示，采用功能康复方案的医学中心应考虑对急性跟腱断裂者采用保守治疗。保守治疗与手术治疗者的跟腱再次断裂率相似，且有利于减少其他并发症。对于不采用早期功能锻炼方案的中心，可选择手术治疗以降低患者跟腱再断裂的风险。论文12月5日发表于《骨与关节外科杂志（美国卷）》[J Bone Joint Surg Am 2012，94（23)：2136]。

　　该研究显示，若采取含早期功能活动的功能康复，无论是否行手术治疗，患者的跟腱再次断裂率相等（风险差异为1.7%，P=0.45）。若未采取早期功能活动，患者可通过手术治疗使绝对风险减少8.8%（P=0.001）。但手术治疗还与除跟腱再次断裂外其他并发症的绝对风险增加15.8%相关（P=0.016）。

　　上述两种治疗方式在小腿围（P=0.357）、肌力（P=0.806）及功能转归（P=0.226）方面无显著差异。




Background
Surgical repair is a common method of treatment of acute Achilles rupture in North America because, despite a higher risk of overall complications, it has been believed to offer a reduced risk of rerupture. However, more recent trials, particularly those using functional bracing with early range of motion, have challenged this belief. The aim of this meta-analysis was to compare surgical treatment and conservative treatment with regard to the rerupture rate, the overall rate of other complications, return to work, calf circumference, and functional outcomes, as well as to examine the effects of early range of motion on the rerupture rate.
Methods 
A literature search, data extraction, and quality assessment were conducted by two independent reviewers. Publication bias was assessed with use of the Egger and Begg tests. Heterogeneity was assessed with use of the I2 test, and fixed or random-effect models were used accordingly. Pooled results were expressed as risk ratios, risk differences, and weighted or standardized mean differences, as appropriate. Meta-regression was employed to identify causes of heterogeneity. Subgroup analysis was performed to assess the effect of early range of motion.
Results
Ten studies met the inclusion criteria. If functional rehabilitation with early range of motion was employed, rerupture rates were equal for surgical and nonsurgical patients (risk difference = 1.7%, p = 0.45). If such early range of motion was not employed, the absolute risk reduction achieved by surgery was 8.8% (p = 0.001 in favor of surgery). Surgery was associated with an absolute risk increase of 15.8% (p = 0.016 in favor of nonoperative management) for complications other than rerupture. Surgical patients returned to work 19.16 days sooner (p = 0.0014). There was no significant difference between the two treatments with regard to calf circumference (p = 0.357), strength (p = 0.806), or functional outcomes (p = 0.226).
Conclusions 
The results of the meta-analysis demonstrate that conservative treatment should be considered at centers using functional rehabilitation. This resulted in rerupture rates similar to those for surgical treatment while offering the advantage of a decrease in other complications. Surgical repair should be preferred at centers that do not employ early-range-of-motion protocols as it decreased the rerupture risk in such patients.    

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    2012-12-23 12498cf9m35(暂无昵称)

    #跟腱断裂#

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    2013-04-19 般若傻瓜

    #急性跟腱断裂#

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    2012-12-23 cmsvly

    #保守治疗#

    0

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    2012-12-23 qingrejiedu

    #JBJS#

    0