El-Akkawi Ali Imad, Joanroy Rajzan, Barfod Kristoffer Weisskirchner, Kallemose Thomas, Kristensen Søren Skydt, Viberg Bjarke
Junior Doctor, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Junior Doctor, Fellowship in Orthopedic Surgery, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
J Foot Ankle Surg. 2018 Mar-Apr;57(2):346-352. doi: 10.1053/j.jfas.2017.06.006. Epub 2017 Sep 30.
Achilles tendon ruptures can be either surgically or conservatively treated with either early functional mobilization or cast immobilization. The purpose of the present study was to conduct a meta-analysis comparing the effect of early versus late weightbearing in conservatively treated adult patients, including only randomized controlled trials (RCTs). The primary endpoint was rerupture, and the secondary endpoints were strength, quality of life during treatment, range of motion, deep venous thrombosis, return to sports, and return to work. The search for studies was conducted using PubMed, EMBASE, and the Cochrane Central Register of Controlled trials. A search was performed, and 2 reviewers independently screened the studies by title, abstract, and, finally, by reading the full text. Four studies met the inclusion criteria. The reference lists of the included studies were scanned and 1 additional RCT study was included. The critical appraisal skills program checklist was applied for study appraisal. A statistician performed the data management and analysis. No statistically significant differences were found between the 2 treatment groups concerning rerupture (p = .796), return to sports (p = .455), or return to work (p = .888). One RCT found 1 case of deep venous thrombosis in the late weightbearing group. One RCT reported significant improvement in quality of life and one reported a significantly improved range of dorsiflexion in the early weightbearing group. No statistically significant difference was found between early and late weightbearing with conservative treatment regarding the rerupture rate. The results of the other outcomes were limited by the low number of studies included in the present meta-analysis. Larger randomized studies are needed to investigate these outcomes. From the results in the present study, we would recommend early weightbearing when an Achilles tendon rupture is treated conservatively.
跟腱断裂可以通过手术或保守治疗，采用早期功能活动或石膏固定。本研究的目的是进行一项荟萃分析，比较保守治疗的成年患者早期与晚期负重的效果，纳入的研究仅为随机对照试验（RCT）。主要终点是再断裂，次要终点是力量、治疗期间的生活质量、活动范围、深静脉血栓形成、恢复运动和恢复工作。通过PubMed、EMBASE和Cochrane对照试验中央注册库进行文献检索。进行了检索，2名评审员独立根据标题、摘要，最后通过阅读全文对研究进行筛选。4项研究符合纳入标准。对纳入研究的参考文献列表进行了筛查，又纳入了1项RCT研究。应用关键评估技能计划清单对研究进行评估。由一名统计学家进行数据管理和分析。在再断裂（p = 0.796）、恢复运动（p = 0.455）或恢复工作（p = 0.888）方面，两个治疗组之间未发现统计学上的显著差异。一项RCT在晚期负重组中发现1例深静脉血栓形成。一项RCT报告早期负重组生活质量有显著改善，另一项报告早期负重组背屈活动范围有显著改善。保守治疗时，早期和晚期负重的再断裂率之间未发现统计学上的显著差异。本荟萃分析纳入的研究数量较少，限制了其他结局的结果。需要更大规模的随机研究来调查这些结局。根据本研究的结果，我们建议在保守治疗跟腱断裂时采用早期负重。
