Holm C, Kjaer M, Eliasson P
Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Scand J Med Sci Sports. 2015 Feb;25(1):e1-10. doi: 10.1111/sms.12209. Epub 2014 Mar 20.
Achilles tendon rupture is a frequent injury with an increasing incidence. Until now, there is no consensus regarding optimal treatment. The aim of this review was to illuminate and summarize randomized controlled trials comparing surgical and non-surgical treatment of Achilles tendon ruptures during the last 10 years. Seven articles were found and they were all acceptable according to international quality assessment guidelines. Primary outcomes were re-ruptures, other complications, and functional outcomes. There was no significant difference in re-ruptures between the two treatments, but a tendency to favoring surgical treatment. Further, one study found an increased risk of soft-tissue-related complications after surgery. Patient satisfaction and time to return to work were significantly different in favor of surgery in one study, and there was also better functional outcome after surgery in some studies. These seven studies indicate that surgical patients have a faster rehabilitation. However, the differences between surgical and non-surgical treatment appear to be subtle and it could mean that rehabilitation is more important, rather than the actual initial treatment. Therefore, further studies will be needed in regard to understanding the interplay between acute surgical or non-surgical treatment, and the rehabilitation regimen for the overall outcome after Achilles tendon ruptures.
跟腱断裂是一种常见且发病率不断上升的损伤。到目前为止，对于最佳治疗方法尚无共识。本综述的目的是阐明并总结过去10年中比较跟腱断裂手术治疗与非手术治疗的随机对照试验。共找到7篇文章，根据国际质量评估指南，这些文章均符合要求。主要结局指标为再断裂、其他并发症及功能结局。两种治疗方法在再断裂方面无显著差异，但有倾向于支持手术治疗的趋势。此外，一项研究发现手术后软组织相关并发症的风险增加。在一项研究中，患者满意度和恢复工作时间在手术组明显更优，并且在一些研究中手术治疗后的功能结局也更好。这7项研究表明手术治疗的患者康复速度更快。然而，手术治疗与非手术治疗之间的差异似乎很细微，这可能意味着康复比实际的初始治疗更为重要。因此，需要进一步开展研究，以了解急性手术或非手术治疗与跟腱断裂后整体结局的康复方案之间的相互作用。
