Huang Jiazhang, Wang Chen, Ma Xin, Wang Xu, Zhang Chao, Chen Li
Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
Am J Sports Med. 2015 Apr;43(4):1008-16. doi: 10.1177/0363546514531014. Epub 2014 May 2.
The choice of rehabilitation management after the surgical repair of acute Achilles tendon (AT) ruptures remains controversial because of insufficient clinical evidence. The current study analyzes the postoperative rehabilitation of AT ruptures based on the current clinical evidence.
To identify and analyze the high-level clinical evidence regarding postoperative rehabilitation after the surgical repair of AT ruptures. Subgroup analyses were also performed to obtain more reliable and specific results.
Meta-analysis.
The studies were retrieved by searching the Medline, Embase, and Cochrane databases through the OVID retrieval engine from 1990 to August 14, 2013. Two independent reviewers critically reviewed the studies using preset inclusion and exclusion criteria. The quality of the eligible studies was assessed by the Cochrane 12-item scale. All included studies were summarized, and their data were extracted. Subgroup analyses were performed according to the different protocols of early functional rehabilitation.
Nine studies, consisting of 6 randomized controlled trials and 3 quasi-randomized studies, were ultimately included. A total of 402 patients were identified. Six of the included studies utilized early weightbearing combined with early ankle motion exercises, while the other 3 only employed early ankle motion exercises. The subgroup analyses demonstrated that 11 of the 15 functional outcome measurements were significantly superior for patients who underwent both early weightbearing and ankle motion exercises than for those who underwent conventional cast immobilization. Similar rates of reruptures (odds ratio [OR], 1.36; 95% CI, 0.38-4.91; P = .64) and major complications (OR, 0.67; 95% CI, 0.24-1.87; P = .44) as well as a significantly lower rate of minor complications (OR, 0.51; 95% CI, 0.27-0.95; P = .03) were also observed in this early functional rehabilitation group. For the patients who solely performed early ankle motion exercises, only 2 of the 14 functional measurements were observed to be significantly superior to immobilization. There were also no significant differences in the rates of reruptures (OR, 0.47; 95% CI, 0.08-2.70; P = .40) and other complications (OR, 1.09; 95% CI, 0.41-2.92; P = .86) between the 2 groups.
Postoperative early weightbearing combined with early ankle motion exercises is associated with a lower minor complication rate and achieves superior and more rapid functional recovery than conventional immobilization after surgical AT repair. In contrast, few advantages were identified when only early ankle motion exercises were applied.
由于临床证据不足，急性跟腱（AT）断裂手术修复后的康复管理选择仍存在争议。本研究基于当前临床证据分析AT断裂的术后康复情况。
识别和分析AT断裂手术修复后术后康复的高级别临床证据。还进行了亚组分析以获得更可靠和具体的结果。
荟萃分析。
通过OVID检索引擎在1990年至2013年8月14日期间检索Medline、Embase和Cochrane数据库来获取研究。两名独立评审员使用预设的纳入和排除标准对研究进行严格评审。符合条件的研究质量通过Cochrane 12项量表进行评估。对所有纳入研究进行总结并提取其数据。根据早期功能康复的不同方案进行亚组分析。
最终纳入9项研究，包括6项随机对照试验和3项半随机研究。共确定了402例患者。其中6项纳入研究采用早期负重联合早期踝关节活动练习，而其他3项仅采用早期踝关节活动练习。亚组分析表明，在15项功能结局测量中，11项对于接受早期负重和踝关节活动练习的患者明显优于接受传统石膏固定的患者。在这个早期功能康复组中还观察到再断裂率（优势比[OR]，1.36；95%可信区间[CI]，0.38 - 4.91；P = 0.64）和主要并发症发生率（OR，0.67；95% CI，0.24 - 1.87；P = 0.44）相似，以及轻微并发症发生率显著更低（OR，0.51；95% CI，0.27 - 0.95；P = 0.03）。对于仅进行早期踝关节活动练习的患者，在14项功能测量中仅观察到2项明显优于固定。两组之间的再断裂率（OR，0.47；95% CI，0.08 - 2.70；P = 0.40）和其他并发症发生率（OR，1.09；95% CI，0.41 - 2.92；P = 0.86）也没有显著差异。
术后早期负重联合早期踝关节活动练习与较低的轻微并发症发生率相关，并且与手术修复AT后传统固定相比，能实现更优且更快的功能恢复。相比之下，仅应用早期踝关节活动练习时几乎没有发现优势。
