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急性跟腱断裂的治疗:系统综述与荟萃分析

Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis.

作者信息

Bhandari Mohit, Guyatt Gordon H, Siddiqui Farhan, Morrow Farrah, Busse Jason, Leighton Ross K, Sprague Sheila, Schemitsch Emil H

机构信息

Department of Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, 1200 Main Street West, Room 2C12, Hamilton, Ontario, L8N 3Z5 Canada.

出版信息

Clin Orthop Relat Res. 2002 Jul(400):190-200. doi: 10.1097/00003086-200207000-00024.

Abstract

A quantitative systematic review of randomized and quasirandomized trials was conducted to determine the effect of surgical versus conservative treatment of acute Achilles tendon ruptures on rates of rerupture. Secondary outcomes included deep infection rates, return to normal function, and minor complaints. A search of computerized databases was conducted to locate clinical studies published from 1969 to 2000. Additional studies were located through hand searches of major orthopaedic journals, bibliographies of major orthopaedic texts, and personal files. Of the 273 citations initially identified, 11 proved potentially eligible, and six met all eligibility criteria. Three investigators independently graded study quality and abstracted relevant data. Among the studies, surgical repair revealed a significant reduction in the risk of rerupture when compared with conservative treatment. Alternatively, the risk of infection with surgical repair was significantly increased. Pooled analysis of studies did not reveal any difference in the risk of minor complaints or return to normal function between surgical repair and conservatively treated groups. Surgical treatment significantly reduces the risk of Achilles tendon rerupture, but increases the risk of infection, when compared with conservative therapy. Wide confidence intervals around the estimates of risk reduction suggest a large trial is needed to establish risks and benefits.

摘要

进行了一项对随机和半随机试验的定量系统评价,以确定急性跟腱断裂的手术治疗与保守治疗对再断裂率的影响。次要结局包括深部感染率、恢复正常功能以及轻微不适。通过检索计算机化数据库查找1969年至2000年发表的临床研究。通过手工检索主要骨科期刊、主要骨科教科书的参考文献以及个人档案找到了其他研究。在最初确定的273篇文献中,11篇被证明可能符合条件,6篇符合所有纳入标准。三名研究人员独立对研究质量进行评分并提取相关数据。在这些研究中,与保守治疗相比,手术修复显示再断裂风险显著降低。另外,手术修复的感染风险显著增加。对研究的汇总分析未显示手术修复组与保守治疗组在轻微不适风险或恢复正常功能方面存在差异。与保守治疗相比,手术治疗显著降低了跟腱再断裂的风险,但增加了感染风险。风险降低估计值周围的宽置信区间表明需要进行一项大型试验来确定风险和益处。

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