Pihl Elsa, Skoldenberg Olof, Nasell Hans, Jonhagen Sven, Kelly Pettersson Paula, Hedbeck Carl Johan
Ortopedkliniken Danderyds sjukhus, Karolinska Institutet Department of Clinical Sciences Danderyd Hospital, Danderyd, Sweden.
BMJ Open Sport Exerc Med. 2019 May 16;5(1):e000511. doi: 10.1136/bmjsem-2019-000511. eCollection 2019.
In the literature on proximal hamstring avulsions, only two studies report the outcomes of non-surgically treated patients. Our objective was to compare subjective recovery after surgical and non-surgical treatment of proximal hamstring avulsions in a middle-aged cohort.
We included 47 patients (33 surgically and 14 non-surgically treated) with a mean (SD) age of 51 (±9) years in a retrospective cohort study. Follow-up time mean (SD) of 3.9 (±1.4) years. The outcome variables were the Lower Extremity Functional Scale (LEFS) and questions from the Proximal Hamstring Injury Questionnaire. Outcome variables were adjusted in regression models for gender, age, American Society of Anestesiologits (ASA) classification and MRI findings at diagnosis.
The baseline characteristics showed no differences except for the MRI result, in which the surgically treated group had a larger proportion of tendons retracted ≥ 2 cm. The mean LEFS score was 74 (SD±12) in the surgically treated cohort and 72 (SD±16) in the non-surgically treated cohort. This was also true after adjusting for confounders. The only difference in outcome at follow-up was the total hours performing physical activity per week, p=0.02; surgically treated patients reported 2.5 hours or more (5.2 vs 2.7).
This study on middle-aged patients with proximal hamstring avulsions was unable to identify any difference in patient-reported outcome measures between surgically and non-surgically treated patients. The vast majority of patients treated surgically had complete proximal hamstring avulsions with ≥ 2 cm of retraction. We conclude that to obtain an evidence-based treatment algorithm for proximal hamstring avulsions studies of higher scientific level are needed.
在有关腘绳肌近端撕脱伤的文献中，仅有两项研究报告了非手术治疗患者的预后情况。我们的目的是比较中年队列中腘绳肌近端撕脱伤手术治疗与非手术治疗后的主观恢复情况。
我们纳入了47例患者（33例接受手术治疗，14例接受非手术治疗），进行一项回顾性队列研究，患者的平均（标准差）年龄为51（±9）岁。随访时间平均（标准差）为3.9（±1.4）年。结局变量为下肢功能量表（LEFS）以及腘绳肌近端损伤问卷中的问题。在回归模型中，对结局变量进行了性别、年龄、美国麻醉医师协会（ASA）分级以及诊断时MRI结果的校正。
除MRI结果外，基线特征无差异，手术治疗组中肌腱回缩≥2 cm的比例更高。手术治疗队列的平均LEFS评分为74（标准差±12），非手术治疗队列的平均LEFS评分为72（标准差±16）。校正混杂因素后情况依然如此。随访时结局的唯一差异是每周进行体育活动的总时长，p = 0.02；手术治疗的患者报告为2.5小时或更长时间（5.2小时对2.7小时）。
这项针对中年腘绳肌近端撕脱伤患者的研究未能发现手术治疗与非手术治疗患者在患者报告的结局指标上存在任何差异。绝大多数接受手术治疗的患者存在完全性腘绳肌近端撕脱伤且回缩≥2 cm。我们得出结论，为获得基于证据的腘绳肌近端撕脱伤治疗方案，需要开展更高科学水平的研究。
