Wong Jason, Barrass Victoria, Maffulli Nicola
Department of Orthopaedic Surgery, University of Aberdeen Medical School, Aberdeen, Scotland.
Am J Sports Med. 2002 Jul-Aug;30(4):565-75. doi: 10.1177/03635465020300041701.
There is no consensus on the best method for management of acute Achilles tendon ruptures. Individual preferences, drawn from experience and study, determine whether treatment is operative or nonoperative.
Our goal was to review the literature to try to determine what management method was the most popular and effective. We wanted to ascertain the best results in terms of complication rates and patient outcomes.
Retrospective review of retrospectively and prospectively collected data.
We analyzed 125 articles in peer-reviewed journals for year of publication, patient numbers, sex, management method, follow-up complications, and patient satisfaction. Each article was graded using a validated methods score. Methods, patient satisfaction, and complication rates were correlated with the year each article was published.
Skin-healing complications were lowest in conservatively managed patients (3 of 578, 0.5%) and highest in open repair and immobilized patients (543 of 3718, 14.6%). General complication rates were lowest in open repair and early-mobilization groups (16 of 238, 6.7%) and highest in percutaneous and early-mobilization groups (19 of 122, 15.6%). Rerupture rates were highest in immobilized conservative management groups (62 of 578, 10.7%) and lowest in groups with external fixation (0%).
In general, the number of publications reporting Achilles tendon ruptures is increasing, the quality of articles is increasing, and the trend for the number of reported complications is decreasing. The published articles had a low methods score (mean, 50.9; range, 25 to 77) and showed a trend toward earlier mobilization. Open repair and early mobilization give the best functional recovery and an acceptable complication rate.
对于急性跟腱断裂的最佳治疗方法尚无共识。根据经验和研究得出的个人偏好决定了治疗是采用手术还是非手术方式。
我们的目标是回顾文献，试图确定哪种治疗方法最受欢迎且最有效。我们希望在并发症发生率和患者预后方面确定最佳结果。
对回顾性和前瞻性收集的数据进行回顾性分析。
我们分析了同行评审期刊上的125篇文章，内容包括发表年份、患者数量、性别、治疗方法、随访并发症及患者满意度。每篇文章使用经过验证的方法评分进行分级。方法、患者满意度和并发症发生率与每篇文章的发表年份相关。
保守治疗患者的皮肤愈合并发症最低（578例中有3例，0.5%），开放修复并固定患者的最高（3718例中有543例，14.6%）。开放修复和早期活动组的总体并发症发生率最低（238例中有16例，6.7%），经皮穿刺和早期活动组的最高（122例中有19例，15.6%）。固定保守治疗组的再断裂率最高（578例中有62例，10.7%），外固定组的最低（0%）。
总体而言，报告跟腱断裂的出版物数量在增加，文章质量在提高，报告的并发症数量呈下降趋势。已发表文章的方法评分较低（平均50.9；范围25至77），且呈现出早期活动的趋势。开放修复和早期活动能带来最佳的功能恢复和可接受的并发症发生率。
