Keating J F, Will E M
Department of Orthopaedic Trauma, Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh EH16 4SU, UK.
J Bone Joint Surg Br. 2011 Aug;93(8):1071-8. doi: 10.1302/0301-620X.93B8.25998.
A total of 80 patients with an acute rupture of tendo Achillis were randomised to operative repair using an open technique (39 patients) or non-operative treatment in a cast (41 patients). Patients were followed up for one year. Outcome measures included clinical complications, range of movement of the ankle, the Short Musculoskeletal Function Assessment (SMFA), and muscle function dynamometry evaluating dorsiflexion and plantar flexion of the ankle. The primary outcome measure was muscle dynamometry. Re-rupture occurred in two of 37 patients (5%) in the operative group and four of 39 (10%) in the non-operative group, which was not statistically significant (p = 0.68). There was a slightly greater range of plantar flexion and dorsiflexion of the ankle in the operative group at three months which was not statistically significant, but at four and six months the range of dorsiflexion was better in the non-operative group, although this did not reach statistically significance either. After 12 weeks the peak torque difference of plantar flexion compared with the normal side was less in the operative than the non-operative group (47% vs 61%, respectively, p < 0.005). The difference declined to 26% and 30% at 26 weeks and 20% and 25% at 52 weeks, respectively. The difference in dorsiflexion peak torque from the normal side was less than 10% by 26 weeks in both groups, with no significant differences. The mean SMFA scores were significantly better in the operative group than the non-operative group at three months (15 vs 20, respectively, p < 0.03). No significant differences were observed after this, and at one year the scores were similar in both groups. We were unable to show a convincing functional benefit from surgery for patients with an acute rupture of the tendo Achillis compared with conservative treatment in plaster.
共有80例跟腱急性断裂患者被随机分为两组，一组采用开放技术进行手术修复（39例患者），另一组采用石膏固定进行非手术治疗（41例患者）。对患者进行了为期一年的随访。观察指标包括临床并发症、踝关节活动范围、简短肌肉骨骼功能评估（SMFA）以及评估踝关节背屈和跖屈的肌肉功能测力法。主要观察指标是肌肉测力法。手术组37例患者中有2例（5%）发生再断裂，非手术组39例患者中有4例（10%）发生再断裂，差异无统计学意义（p = 0.68）。术后三个月，手术组踝关节跖屈和背屈的活动范围略大，但差异无统计学意义；术后四个月和六个月，非手术组的背屈范围更好，不过也未达到统计学意义。术后12周，手术组与正常侧相比，跖屈的峰值扭矩差异低于非手术组（分别为47%和61%，p < 0.005）。该差异在术后26周降至26%和30%，在术后52周降至20%和25%。两组在术后26周时与正常侧相比背屈峰值扭矩差异均小于10%，无显著差异。术后三个月，手术组的平均SMFA评分显著优于非手术组（分别为15和20，p < 0.03）。此后未观察到显著差异，一年时两组评分相似。与石膏保守治疗相比，我们未能证明手术治疗对跟腱急性断裂患者有令人信服的功能益处。
