Baltes T P A, Zwiers R, Wiegerinck J I, van Dijk C N
Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2017 Jun;25(6):1817-1838. doi: 10.1007/s00167-016-4062-9. Epub 2016 Mar 12.
The aim of this study was to systematically evaluate the available literature on surgical treatment for midportion Achilles tendinopathy and to provide an overview of the different surgical techniques.
A systematic review of the literature available in MEDLINE, EMBASE and the Cochrane database of controlled trials was performed. The primary outcome measure in terms of patient satisfaction and the secondary outcome measures that consisted of complication rate, pain score, functional outcome score and success rate were evaluated. The Downs & Black checklist and the Coleman methodology scale were used to assess the methodological quality of included articles.
Of 1090 reviewed articles, 23 met the inclusion criteria. The included studies reported on the results of 1285 procedures in 1177 patients. The surgical techniques were divided into five categories. Eleven studies evaluated open surgical debridement, seven studies described minimally invasive procedures, three studies evaluated endoscopic procedures, one study evaluated open gastrocnemius lengthening, and one study reported on open autologous tendon transfer. Results regarding patient satisfaction (69-100 %) and complication rate (0-85.7 %) varied widely.
This study demonstrates the large variation in surgical techniques available for treatment of midportion Achilles tendinopathy. None of the included studies compared surgical intervention with nonsurgical or placebo intervention. Minimally invasive and endoscopic procedures yield lower complication rates with similar patient satisfaction in comparison with open procedures. Minimally invasive and endoscopic procedures might therefore prove to be the future of surgical treatment of Achilles midportion tendinopathy.
IV.
本研究旨在系统评价有关跟腱中段肌腱病手术治疗的现有文献，并概述不同的手术技术。
对MEDLINE、EMBASE和Cochrane对照试验数据库中的文献进行系统综述。评估了以患者满意度为主要结局指标，以及包括并发症发生率、疼痛评分、功能结局评分和成功率在内的次要结局指标。采用Downs & Black清单和Coleman方法量表评估纳入文章的方法学质量。
在1090篇综述文章中，23篇符合纳入标准。纳入研究报告了1177例患者1285例手术的结果。手术技术分为五类。11项研究评估了开放性手术清创，7项研究描述了微创手术，3项研究评估了内镜手术，1项研究评估了开放性腓肠肌延长术，1项研究报告了开放性自体肌腱转移术。患者满意度（69%-100%）和并发症发生率（0%-85.7%）的结果差异很大。
本研究表明，治疗跟腱中段肌腱病的手术技术差异很大。纳入研究均未将手术干预与非手术或安慰剂干预进行比较。与开放性手术相比，微创手术和内镜手术并发症发生率较低，患者满意度相似。因此，微创手术和内镜手术可能是跟腱中段肌腱病手术治疗的未来方向。
IV级。
