Blakeney William G, Zilko Simon R, Edmonston Steven J, Schupp Natalie E, Annear Peter T
Department of Orthopaedic Surgery, Bunbury Regional Hospital, Bunbury, WA, Australia.
Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Knee Surg Sports Traumatol Arthrosc. 2017 Jun;25(6):1943-1950. doi: 10.1007/s00167-017-4475-0. Epub 2017 Mar 9.
Avulsion of the proximal hamstring tendons is an uncommon injury. To date, few studies have prospectively evaluated outcomes of surgical repair. The aim of the present study is to review the functional outcomes of surgical repair of proximal hamstring tendon avulsions.
This is a prospective series of 96 consecutive proximal hamstring surgical repairs in 94 patients, with a median age of 50 years and median follow-up of 33 months (range 12-58). Functional outcomes were assessed using the Perth Hamstring Assessment Tool (PHAT)-a validated scoring system for proximal hamstring injuries.
Significant improvements in functional outcomes were seen across all patients at 1-year follow-up. There was a mean PHAT score improvement of 34.7 points at the 1-year follow-up (p < 0.001, 95% CI 29.9-39.5). The SF-12 PCS scores showed a significant improvement at 1-year follow-up of 13.8 points (p < 0.001, 95% CI 10.7-16.9). These were maintained at final follow-up. Acute repairs had significantly higher improvement in PHAT score with acute patients improving a mean of 38.6 points (p < 0.001, 95% CI 32.0-44.3) and chronic patients only improving by a mean of 25.3 points (p < 0.001, 95% CI 18.2-33.3) at final follow-up.
This study establishes that surgical repair of proximal hamstring tendon ruptures leads to improved patient outcomes, in both acute and chronic repairs. Early surgical repair, however, achieves superior outcomes to late repair. These results suggest that surgeons should be operating on proximal hamstring avulsions, and preferably in the acute stage.
II.
腘绳肌近端肌腱撕脱是一种罕见的损伤。迄今为止，很少有研究对手术修复的结果进行前瞻性评估。本研究的目的是回顾腘绳肌近端肌腱撕脱手术修复的功能结果。
这是一项对94例患者进行的96例连续腘绳肌近端手术修复的前瞻性系列研究，患者中位年龄为50岁，中位随访时间为33个月（范围12 - 58个月）。使用珀斯腘绳肌评估工具（PHAT）评估功能结果，该工具是一种针对腘绳肌近端损伤的有效评分系统。
在1年随访时，所有患者的功能结果均有显著改善。1年随访时PHAT评分平均提高34.7分（p < 0.001，95%可信区间29.9 - 39.5）。SF - 12身体功能评分在1年随访时显著提高13.8分（p < 0.001，95%可信区间10.7 - 16.9）。这些结果在最终随访时得以维持。急性修复组的PHAT评分改善明显更高，急性患者在最终随访时平均改善38.6分（p < 0.001，95%可信区间32.0 - 44.3），而慢性患者仅平均改善25.3分（p < 0.001，95%可信区间18.2 - 33.3）。
本研究表明，腘绳肌近端肌腱断裂的手术修复可改善患者预后，无论是急性还是慢性修复。然而，早期手术修复的效果优于晚期修复。这些结果表明外科医生应进行腘绳肌近端撕脱的手术，最好在急性期进行。
II级。
