Deng Senlin, Sun Zhengyu, Zhang Chenghao, Chen Gang, Li Jian
Orthopedist, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Orthopedist, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China; Professor, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
J Foot Ankle Surg. 2017 Nov-Dec;56(6):1236-1243. doi: 10.1053/j.jfas.2017.05.036.
Acute Achilles tendon ruptures can be treated with surgical and nonsurgical treatment. However, the optimal intervention for acute Achilles tendon rupture remains controversial. The aim of the present study was to compare the clinical outcomes of surgical treatment versus conservative management for acute Achilles tendon rupture. Eight randomized controlled studies involving 762 patients were included in the meta-analysis. In general, re-rupture occurred in 14 of 381 surgically treated patients (3.7%) and 37 of 377 nonsurgically treated patients (9.8%). Pooled results showed that the total re-rupture rate was significantly lower in surgical group than that in the nonsurgical group (risk ratio 0.38, 95% confidence interval 0.21 to 0.68; p = .001). No significant differences were found between the 2 treatment groups in the incidence of deep venous thrombosis, the number who returned to sport, ankle range of motion (dorsiflexion, plantarflexion), Achilles tendon total rupture score, or physical activity scale. Surgical treatment can effectively reduce the re-rupture rate and might be a better choice for the treatment of acute Achilles tendon rupture. Multicenter, double-blind randomized controlled trials with stratification and long-term follow-up are needed to obtain a higher level of evidence and to guide clinical practice, especially in the comparison and selection of different treatments.
急性跟腱断裂可采用手术和非手术治疗。然而，急性跟腱断裂的最佳干预措施仍存在争议。本研究的目的是比较手术治疗与保守治疗急性跟腱断裂的临床疗效。荟萃分析纳入了八项涉及762例患者的随机对照研究。总体而言，381例接受手术治疗的患者中有14例（3.7%）发生再次断裂，377例接受非手术治疗的患者中有37例（9.8%）发生再次断裂。汇总结果显示，手术组的总再次断裂率显著低于非手术组（风险比0.38，95%置信区间0.21至0.68；p = 0.001）。在深静脉血栓形成发生率、恢复运动的人数、踝关节活动范围（背屈、跖屈）、跟腱总断裂评分或身体活动量表方面，两个治疗组之间未发现显著差异。手术治疗可有效降低再次断裂率，可能是治疗急性跟腱断裂的更好选择。需要进行多中心、分层、长期随访的双盲随机对照试验，以获得更高水平的证据并指导临床实践，尤其是在不同治疗方法的比较和选择方面。
