Royal Prince Alfred Hospital, Sydney, Australia.
University of Malta Medical School, University of Malta, Malta.
Bone Joint J. 2020 Jul;102-B(7):933-940. doi: 10.1302/0301-620X.102B7.BJJ-2019-0783.R3.
The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial.
PROMs including the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS), EuroQol five-dimension (EQ-5D), satisfaction, net promoter score and data regarding re-rupture, and venous thromboembolic rates were collected for patients randomized to receive either operative or nonoperative treatment for acute Achilles tendon rupture in a previous study. Of the 80 patients originally randomized, 64 (33 treated surgically, 31 nonoperatively) patients were followed up at a mean of 15.7 years (13.4 to 17.7).
There was no statistically significant difference between operatively and nonoperatively treated patients, in SMFA Dysfunction Index (median 1.56 (interquartile range (IQR) 0 to 5.51) vs 1.47 (IQR 0 to 5.15); p = 0.289), SMFA Bother Index (2.08 (IQR 0 to 12.50) vs 0.00 (IQR 0 to 6.25); p = 0.074), ATRS (94 (IQR 86 to 100) vs 95 (IQR 81 to 100); p = 0.313), EQ-5D-5L (1 (IQR 0.75 to 1) vs 1 (IQR 0.84 to 1); p = 0.137) or EQ-5D health today visual analogue score (85 (IQR 72.5 to 95) vs 85 (IQR 8 to 95); p = 0.367). There was no statistically significant difference between operative and nonoperative groups in terms of satisfaction (84% vs 100%; p = 0.119) or willingness to recommend treatment to friends or family (79% vs 87%; p = 0.255). Four nonoperative patients and two in the operative group sustained a re-rupture (p = 0.306).
Both patient groups reported good results at long-term follow-up. The findings give no evidence of superior long-term patient reported outcomes (as measured by the SMFA) for surgical treatment over nonoperative treatment. There was no demonstrable difference in other patient reported outcome measures, satisfaction, or re-rupture rates at long-term follow-up. Cite this article: 2020;102-B(7):933-940.
本研究旨在通过一项随机对照试验，比较急性跟腱断裂手术与非手术治疗的患者长期报告的结局测量指标（PROMs）。
在之前的研究中，对随机接受手术或非手术治疗的急性跟腱断裂患者收集 PROMs，包括短肌肉骨骼功能评估（SMFA）、跟腱总断裂评分（ATRS）、欧洲五维健康量表（EQ-5D）、满意度、净推荐值以及再断裂和静脉血栓栓塞发生率数据。在最初随机的 80 例患者中，64 例（33 例手术治疗，31 例非手术治疗）患者平均随访 15.7 年（13.4 至 17.7 年）。
手术组和非手术组患者的 SMFA 功能障碍指数（中位数 1.56（四分位距（IQR）0 至 5.51）与 1.47（IQR 0 至 5.15）；p = 0.289）、SMFA 困扰指数（2.08（IQR 0 至 12.50）与 0.00（IQR 0 至 6.25）；p = 0.074）、ATRS（94（IQR 86 至 100）与 95（IQR 81 至 100）；p = 0.313）、EQ-5D-5L（1（IQR 0.75 至 1）与 1（IQR 0.84 至 1）；p = 0.137）或 EQ-5D 今日健康视觉模拟评分（85（IQR 72.5 至 95）与 85（IQR 8 至 95）；p = 0.367）均无统计学显著差异。在满意度（84% 对 100%；p = 0.119）或向朋友或家人推荐治疗的意愿（79% 对 87%；p = 0.255）方面，手术组和非手术组无统计学显著差异。4 例非手术患者和 2 例手术患者发生再断裂（p = 0.306）。
两组患者在长期随访中均报告了良好的结果。研究结果并未证明手术治疗在长期随访中优于非手术治疗的患者报告结局（以 SMFA 测量）。在其他患者报告结局测量、满意度或再断裂率方面，在长期随访中无明显差异。
