The Ohio State University, Orthopaedics, Columbus, USA.
Int J Sports Med. 2011 Jul;32(7):490-5. doi: 10.1055/s-0031-1273753. Epub 2011 May 11.
Proximal hamstring ruptures are increasingly treated surgically, despite little high-level supporting evidence. We sought to determine whether there are differences in clinical outcome after surgical vs. non-surgical treatment of proximal hamstring tendinous avulsions/ruptures and acute vs. chronic surgical repair of tendinous avulsions. Multiple medical databases were searched for Level I-IV evidence. 18 studies were included. 298 subjects (300 proximal hamstring injuries) were analyzed with mean age of 39.7 years. 286 injuries were managed with surgical repair vs. 14 non-operative. 95 surgical cases were performed within 4 weeks of the injury (acute), while 191 were performed beyond 4 weeks (chronic). 292 injuries were tendinous avulsions while 8 were bony tuberosity avulsions. Surgical repair resulted in significantly (p < 0.05) better subjective outcomes, greater rate of return to pre-injury level of sport, and greater strength/endurance than non-surgical management. Similarly, acute surgical repair had significantly better patient satisfaction, subjective outcomes, pain relief, strength/endurance, and higher rate of return to pre-injury level of sport than chronic repair (p < 0.001) with reduced risk of complications and re-rupture (p < 0.05). Chronic surgical repair also improves outcomes, strength and endurance, and return-to-sport, but not as well as acute repair. Non-operative treatment results in reduced patient satisfaction, with significantly lower rates of return to pre-injury level of sport and reduced hamstring muscle strength.
尽管缺乏高水平的支持证据，近段腘绳肌断裂越来越多地采用手术治疗。我们旨在确定手术治疗与非手术治疗近段腘绳肌腱撕脱/断裂和急性与慢性手术修复肌腱撕脱的临床结果是否存在差异。检索了多个医学数据库以获取 I-IV 级证据。纳入了 18 项研究。共分析了 298 例患者（300 例近段腘绳肌损伤），平均年龄为 39.7 岁。286 例损伤采用手术修复，14 例采用非手术治疗。95 例手术在损伤后 4 周内进行（急性），191 例在 4 周后进行（慢性）。292 例损伤为肌腱撕脱，8 例为骨突撕脱。与非手术治疗相比，手术修复的主观结果明显（p < 0.05）更好，重返伤前运动水平的比例更高，力量/耐力更强。同样，与慢性修复相比，急性手术修复的患者满意度、主观结果、疼痛缓解、力量/耐力和重返伤前运动水平的比例更高（p < 0.001），并发症和再断裂的风险降低（p < 0.05）。慢性手术修复也能改善结果、力量和耐力以及重返运动，但不如急性修复。非手术治疗的患者满意度降低，重返伤前运动水平的比例明显较低，腘绳肌力量也降低。
