Zhou Ke, Song Lei, Zhang Peng, Wang Chengshuang, Wang Wenliang
Surgeon, Joint Surgery of The First People's Hospital of Jingmen, Hubei, China.
Surgeon, Postgraduate Training Base, Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Jinzhou Medical University, Tianjin, China.
J Foot Ankle Surg. 2018 Nov-Dec;57(6):1191-1199. doi: 10.1053/j.jfas.2018.05.007.
We performed a meta-analysis to (1) compare surgical and non-surgical treatment methods for repair of acute rupture of the Achilles tendon, in terms of the re-rupture rate, incidence of complications other than re-rupture, functional outcomes, and proportion of patients returning to previous levels of sporting activities, and (2) explore the difference in the re-rupture rate if proven early functional rehabilitation protocols were followed. PubMed, EMBASE, Medline, and Cochrane Central Register of Controlled Trials databases were searched to identify randomized clinical trials. The quality of included studies was assessed by the Cochrane risk-of-bias tool. The random-effects model or subgroup analysis would be chosen to perform the meta-analysis if the data were heterogeneous; otherwise, the fixed-effect model would be selected. Ten randomized clinical trials with a total of 934 randomized patients were included. Patients in the non-surgical group underwent higher re-ruptures than patients in the surgical group (p = .0002), but the re-rupture rates were equivalent in the non-surgical group and the surgical group (p = .08) if an early range of motion exercises protocol was performed. Lower incidence of complications excluding re-rupture was found in non-surgical patients (p = .006). However, the surgical group had better results in functional outcomes when evaluated by 2 different jump tests (drop counter-movement jump [p = .002], Hopping [p = .004]) and 1 muscular endurance test (Heel-rise work [p = .01]). The 2 groups had no significant difference in the proportion of patients returning to previous levels of sporting activities (p = 0.87). The risk of re-rupture after surgical or non-surgical treatment was equivalent if a functional rehabilitation protocol with early range of motion was performed, but the risk of other complications happening after surgical treatment was higher than in non-surgical treatment.
我们进行了一项荟萃分析，以（1）比较手术和非手术治疗方法修复急性跟腱断裂的再断裂率、除再断裂外的并发症发生率、功能结局以及恢复到先前运动水平的患者比例，（2）探讨遵循经证实的早期功能康复方案时再断裂率的差异。检索了PubMed、EMBASE、Medline和Cochrane对照试验中央注册库数据库，以识别随机临床试验。采用Cochrane偏倚风险工具评估纳入研究的质量。如果数据存在异质性，则选择随机效应模型或亚组分析进行荟萃分析；否则，选择固定效应模型。纳入了10项随机临床试验，共934例随机患者。非手术组患者的再断裂率高于手术组患者（p = 0.0002），但如果执行早期活动度锻炼方案，非手术组和手术组的再断裂率相当（p = 0.08）。非手术患者除再断裂外的并发症发生率较低（p = 0.006）。然而，通过2种不同的跳跃测试（下落反向运动跳跃 [p = 0.002]，单脚跳 [p = 0.004]）和1项肌肉耐力测试（提踵功 [p = 0.01]）评估时，手术组的功能结局更好。两组在恢复到先前运动水平的患者比例方面无显著差异（p = 0.87）。如果执行早期活动度的功能康复方案，手术或非手术治疗后的再断裂风险相当，但手术治疗后发生其他并发症的风险高于非手术治疗。
