Olsson Nicklas, Petzold Max, Brorsson Annelie, Karlsson Jón, Eriksson Bengt I, Silbernagel Karin Grävare
Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Mölndal, Sweden
Centre for Applied Biostatistics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
Am J Sports Med. 2014 Jun;42(6):1448-55. doi: 10.1177/0363546514527409. Epub 2014 Mar 21.
In patients with an acute Achilles tendon rupture, it has not been possible to determine the superiority of a single specific treatment modality over other treatments with respect to symptoms and function. When several pertinent treatment protocols are available for an injury, it is of interest to understand how other variables, such as age, sex, or physical activity level, affect outcome to better individualize the treatment.
To investigate predictors of both symptomatic and functional outcomes after an acute Achilles tendon rupture.
Cohort study (Prognosis); Level of evidence, 2.
Ninety-three patients (79 men and 14 women; mean age, 40 years) were evaluated prospectively at 3, 6, and 12 months. The main outcome measures in this study were the Achilles tendon Total Rupture Score (ATRS) for symptoms and maximum heel-rise height for function. The independent variables evaluated as possible predictors of outcome included treatment, sex, age, body mass index (BMI), physical activity level, symptoms, and quality of life.
Treatment, age, BMI, physical activity level, heel-rise height at 6 months, and the ATRS at 3 months were eligible for further analysis. Only male sex was included for the prediction models. The 4 different multiple linear regression models (predicting the ATRS at 6 and 12 months and heel-rise height at 6 and 12 months) were significant (P < .001-.002), and the R (2) values for the models were 0.222 to 0.409. Surgical or nonsurgical treatment is a moderate predictor of symptoms and a weak predictor of heel-rise height after an acute Achilles tendon rupture. At the 6-month follow-up, surgical treatment was associated with a larger heel-rise height, but the opposite was seen at 12 months. Surgical treatment resulted in a lower degree of symptoms. Increasing age was a strong predictor of reduced heel-rise height, and an increase in age of 10 years reduced the expected heel-rise height by approximately 8%. A higher BMI was also a strong predictor of a greater degree of symptoms, and a 5-unit higher BMI predicted a reduction of approximately 10 points in the ATRS.
The present study identified important possible predictors of outcome. Despite having a wide range of clinically relevant variables, the models had a limited ability to predict the final individual outcome. In general, the models appear to be better at predicting function than symptoms.
在急性跟腱断裂患者中，就症状和功能而言，尚未能够确定单一特定治疗方式优于其他治疗方法。当针对某一损伤有几种相关治疗方案时，了解诸如年龄、性别或身体活动水平等其他变量如何影响治疗结果以更好地实现个体化治疗是很有意义的。
研究急性跟腱断裂后症状性和功能性结果的预测因素。
队列研究（预后）；证据等级，2级。
对93例患者（79例男性和14例女性；平均年龄40岁）在3个月、6个月和12个月时进行前瞻性评估。本研究的主要结局指标是用于评估症状的跟腱完全断裂评分（ATRS）和用于评估功能的最大提踵高度。作为可能的结局预测因素进行评估的独立变量包括治疗方式、性别、年龄、体重指数（BMI）、身体活动水平、症状和生活质量。
治疗方式、年龄、BMI、身体活动水平、6个月时的提踵高度以及3个月时的ATRS符合进一步分析的条件。预测模型仅纳入了男性性别。4种不同的多元线性回归模型（预测6个月和12个月时的ATRS以及6个月和12个月时的提踵高度）具有显著性（P <.001-.002），模型的R（2）值为0.222至0.409。手术或非手术治疗是急性跟腱断裂后症状的中度预测因素，是提踵高度的弱预测因素。在6个月随访时，手术治疗与更大的提踵高度相关，但在12个月时情况相反。手术治疗导致症状程度较低。年龄增加是提踵高度降低的强预测因素，年龄每增加10岁，预期提踵高度降低约8%。较高的BMI也是症状程度较高的强预测因素，BMI每高5个单位，预测ATRS降低约10分。
本研究确定了重要的可能结局预测因素。尽管有广泛的临床相关变量，但模型预测最终个体结局的能力有限。总体而言，模型在预测功能方面似乎比预测症状更好。
