Young Simon W, Patel Alpesh, Zhu Mark, van Dijck Stephanie, McNair Peter, Bevan Wesley P, Tomlinson Matthew
836 Peary Lane, Foster City, San Mateo, CA 94404. E-mail address:
Department of Orthopaedic Surgery, Middlemore Hospital, 100 Hospital Road, Papatoetoe 2025, Auckland, New Zealand.
J Bone Joint Surg Am. 2014 Jul 2;96(13):1073-1079. doi: 10.2106/JBJS.M.00248.
The rate of Achilles tendon ruptures is increasing, but there is a lack of consensus on treatment of acute injuries. The purpose of this trial was to compare outcomes of weight-bearing casts with those of traditional casts in the treatment of acute Achilles tendon ruptures.
Eighty-four patients with an acute Achilles tendon rupture were recruited over a two-year period. Patients were randomized to be treated with either a weight-bearing cast with a Böhler iron or a non-weight-bearing cast for eight weeks. Patients underwent muscle dynamometry testing at six months, with additional follow-up at one and two years. The primary outcomes that were assessed were the rerupture rate and the time taken to return to work. Secondary outcomes included return to sports, ankle pain and stiffness, footwear restrictions, and patient satisfaction.
There were no significant differences between groups with regard to patient demographics or activity levels prior to treatment. At the time of follow-up at two years, one (3%) of the thirty-seven patients in the weight-bearing group and two (5%) of the thirty-seven in the non-weight-bearing group had sustained a rerupture (p = 0.62). The patients in the weight-bearing group experienced less subjective stiffness at one year. There were no significant differences in time taken to return to work, Leppilahti scores, patient satisfaction, pain, or return to sports between the groups.
Use of weight-bearing casts for the nonoperative treatment of Achilles tendon ruptures appears to offer outcomes that are at least equivalent to those of non-weight-bearing casts. The overall rerupture rate in this study was low, supporting the continued use of initial nonoperative management for the treatment of acute Achilles tendon ruptures.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
跟腱断裂的发生率正在上升，但对于急性损伤的治疗尚无共识。本试验的目的是比较负重石膏与传统石膏治疗急性跟腱断裂的效果。
在两年期间招募了84例急性跟腱断裂患者。患者被随机分为接受带Böhler铁的负重石膏或非负重石膏治疗8周。患者在6个月时接受肌肉测力测试，并在1年和2年时进行额外随访。评估的主要结局是再断裂率和恢复工作所需时间。次要结局包括恢复运动、踝关节疼痛和僵硬、鞋类限制以及患者满意度。
两组在治疗前的患者人口统计学或活动水平方面无显著差异。在两年随访时，负重组37例患者中有1例（3%）发生再断裂，非负重组37例患者中有2例（5%）发生再断裂（p = 0.62）。负重组患者在1年时主观僵硬感较轻。两组在恢复工作时间、Leppilahti评分、患者满意度、疼痛或恢复运动方面无显著差异。
使用负重石膏非手术治疗跟腱断裂似乎能提供至少与非负重石膏相当的效果。本研究中的总体再断裂率较低，支持继续采用初始非手术治疗急性跟腱断裂。
治疗性I级。有关证据水平的完整描述，请参阅作者须知。
