Lim Che Siu, Lees David, Gwynne-Jones David P
1 Whangarei Hospital, Orthopaedic Outpatients, Whangarei, New Zealand.
2 Waikato District Health Board, Hamilton, New Zealand.
Foot Ankle Int. 2017 Dec;38(12):1331-1336. doi: 10.1177/1071100717728687. Epub 2017 Sep 9.
The purpose of this study was to compare the functional results of operative and nonoperative treatment of acute Achilles tendon rupture using an identical rehabilitation program of functional bracing.
Over a 10-year period, 200 patients (99 operative, 101 nonoperative) aged between 18 and 65 years were treated at our institution's physiotherapy department after acute Achilles tendon rupture. There were 132 patients (62 operative, 70 nonoperative) available for a minimum 2-year follow-up (average 6.5 years; range, 2-13 years). Functional outcome was assessed using the Achilles tendon total rupture score (ATRS).
With the numbers available, no significant difference could be detected in ATRS between operative (mean 84.8, median 90) and nonoperative groups (mean 85.3, median 91; P = 0.55). No significant difference could be detected in ATRS between male and female patients however treated ( P = 0.30) or between patients younger and older than 40 years at time of injury ( P = 0.68). There was no correlation between ATRS score and age at injury in all patients (ρ = -0.0168, P = 0.85). In male patients, there was a weak trend with older patients at follow-up having better scores (ρ = 0.21, P = 0.069). However, among female patients, there was a significant negative correlation between ATRS scores and increasing age (ρ = -0.29, P = 0.03). Logistic regression analysis failed to show any significant effect of age at rupture, gender, or mode of treatment on ATRS.
This study showed no significant difference detectable in ATRS between operative and nonoperative patients in the treatment of acute Achilles tendon ruptures using an identical rehabilitation program with functional bracing.
Level II, prospective comparative study.
本研究的目的是比较采用相同的功能性支具康复方案对急性跟腱断裂进行手术治疗和非手术治疗的功能结果。
在10年期间，我们机构理疗科对18至65岁的200例急性跟腱断裂患者进行了治疗（99例手术治疗，101例非手术治疗）。其中132例患者（62例手术治疗，70例非手术治疗）可进行至少2年的随访（平均6.5年；范围2至13年）。使用跟腱完全断裂评分（ATRS）评估功能结果。
就现有数据而言，手术治疗组（平均84.8，中位数90）和非手术治疗组（平均85.3，中位数91；P = 0.55）的ATRS评分无显著差异。无论采用何种治疗方式，男性和女性患者的ATRS评分均无显著差异（P = 0.30），受伤时年龄小于40岁和大于40岁的患者之间也无显著差异（P = 0.68）。所有患者的ATRS评分与受伤年龄之间均无相关性（ρ = -0.0168，P = 0.85）。在男性患者中，存在一种微弱趋势，即随访时年龄较大的患者评分较高（ρ = 0.21，P = 0.069）。然而，在女性患者中，ATRS评分与年龄增长之间存在显著负相关（ρ = -0.29，P = 0.03）。逻辑回归分析未显示断裂时年龄、性别或治疗方式对ATRS有任何显著影响。
本研究表明，在采用相同的功能性支具康复方案治疗急性跟腱断裂时，手术治疗患者和非手术治疗患者的ATRS评分无显著差异。
二级，前瞻性比较研究。
