Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Am J Sports Med. 2018 Jun;46(7):1767-1772. doi: 10.1177/0363546517702872. Epub 2017 May 3.
Although simple end-to-end repair of the Achilles tendon is common, many augmented repair protocols have been implemented for acute Achilles tendon rupture. However, whether augmented repair is better than nonaugmented repair of an acute Achilles tendon rupture is still unknown.
To conduct a meta-analysis to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes assessed included infections, ankle range of motion, calf muscle strength, and minor complications.
Meta-analysis.
A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials (RCTs) comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE. The keywords (Achilles tendon rupture) AND (surg* OR operat* OR repair* OR augment* OR non-augment* OR end-to-end OR sutur*) were combined, and results were limited to human RCTs and controlled clinical trials published in the English language. Four RCTs involving 169 participants were eligible for inclusion; 83 participants were treated with augmented repair and 86 were treated with nonaugmented repair.
Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture (93% vs 90%, respectively; P = .53). The rerupture rates showed no significant difference for augmented versus nonaugmented repair (7.2% vs 9.3%, respectively; P = .69). No differences in superficial and deep infections occurred in augmented (7 infections) and nonaugmented (8 infections) repair groups during postoperative follow-up ( P = .89). The average incisional infection rate was 8.4% with augmented repair and 9.3% with nonaugmented repair. No significant differences in other complications were found between augmented (7.2%) and nonaugmented (8.1%) repair ( P = .80).
Augmented repair, when compared with nonaugmented repair, was not found to improve patient satisfaction or reduce rerupture rate or infection rate. These conclusions are based on 4 trials with small sample sizes, and larger randomized trials are required to confirm these results.
尽管单纯的跟腱端端吻合术很常见，但许多增强修复方案已被应用于急性跟腱断裂。然而，增强修复是否优于急性跟腱断裂的非增强修复尚不清楚。
进行荟萃分析，以确定急性跟腱断裂的增强手术修复是否可以在不增加再断裂率的情况下提高患者的主观满意度。次要结果评估包括感染、踝关节活动范围、小腿肌肉力量和小并发症。
荟萃分析。
系统地检索了 1980 年 1 月至 2016 年 8 月期间在 PubMed、Web of Science（SCI-E/SSCI/A&HCI）和 EMBASE 等电子数据库中发表的所有比较急性跟腱断裂增强修复和非增强修复的随机对照试验（RCT）。关键词（跟腱断裂）和（手术或操作或修复或增强或非增强或端端吻合或缝合*）相结合，并将结果仅限于人类 RCT 和以英语发表的对照临床试验。共有 4 项 RCT 纳入了 169 名参与者，其中 83 名接受了增强修复，86 名接受了非增强修复。
增强修复与非增强修复相比，对急性跟腱断裂的治疗效果相似（分别为 93%和 90%，P =.53）。再断裂率在增强修复和非增强修复之间无显著差异（分别为 7.2%和 9.3%，P =.69）。在术后随访期间，增强修复组（7 例感染）和非增强修复组（8 例感染）均未发生浅表和深部感染（P =.89）。增强修复的切口感染率平均为 8.4%，非增强修复的切口感染率为 9.3%。增强修复和非增强修复的其他并发症发生率无显著差异（分别为 7.2%和 8.1%，P =.80）。
与非增强修复相比，增强修复并未发现能提高患者满意度或降低再断裂率或感染率。这些结论基于 4 项样本量较小的试验，需要更大规模的随机试验来证实这些结果。
