根据移位程度选择治疗方法对腘绳肌起点撕脱骨折进行手术和非手术治疗的满意临床结果：一项系统评价
Satisfactory clinical outcome of operative and non-operative treatment of avulsion fracture of the hamstring origin with treatment selection based on extent of displacement: a systematic review.
作者信息
Nauta Hijleke J A, van der Made Anne D, Tol Johannes L, Reurink Gustaaf, Kerkhoffs Gino M
机构信息
Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2021 Jun;29(6):1813-1821. doi: 10.1007/s00167-020-06222-y. Epub 2020 Aug 18.
PURPOSE
To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm) displacement, and early (≤ 4 weeks) and delayed (> 4 weeks) surgery.
METHODS
A systematic literature search was performed using PubMed, Cochrane, Embase, CINAHL and SPORTDiscus. A quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale.
RESULTS
Eight studies with 90 patients (mean age: 16 years) were included. All studies had low methodological quality (PEDro score ≤ 5). Operative treatment yielded a return to preinjury activity rate (RTPA) of 87% (95% CI: 68-95), return to sports (RTS) rate of 100% (95% CI: 82-100), Harris hip score (HHS) of 99 (range 96-100) and a University of California Los Angeles activity scale (UCLA) score of 100%. Non-operative treatment yielded a RTPA rate of 100% (95% CI:68-100), RTS rate of 86% (95% CI: 69-94), HHS score of 99 (range 96-100), and non-union rate of 18% (95% CI: 9-34). All patients with minor displacement were treated non-operatively (RTPA: 100% [95% CI: 21-100], RTS: 100% [95% CI: 51-100]). For major displacement, operative treatment led to RTPA and RTS rates of 86% (95% CI: 65-95) and 100% (95% CI: 84-100), and 0% (0/1, 95% CI: 0-79) and 100% (95% CI: 51-100) for non-operative treatment. Early surgery yielded RTPA and RTS rates of 100% (95% CI: 34-100 & 57-100) compared to 100 (95% CI: 72-100) and 90% (95% CI: 60-98) for delayed repair.
CONCLUSION
All included studies have high risk of bias. There is only low level of evidence with a limited number of included patients to compare outcome of operative and non-operative treatment. Overall outcome was satisfactory. There is a treatment selection phenomenon based on displacement, with acceptable outcome in both groups. There is insufficient data to draw conclusions regarding timing of surgery.
LEVEL OF EVIDENCE
IV.
目的
比较手术治疗与非手术治疗腘绳肌起点撕脱骨折的疗效，这些骨折存在微小（<1.5 cm）和严重（≥1.5 cm）移位，以及早期（≤4周）和延迟（>4周）手术情况。
方法
使用PubMed、Cochrane、Embase、CINAHL和SPORTDiscus进行系统文献检索。使用物理治疗证据数据库（PEDro）量表进行质量评估。
结果
纳入8项研究，共90例患者（平均年龄：16岁）。所有研究的方法学质量均较低（PEDro评分≤5）。手术治疗的伤前活动恢复率（RTPA）为87%（95%CI：68 - 95），运动恢复率（RTS）为100%（95%CI：82 - 100），Harris髋关节评分（HHS）为99（范围96 - 100），加利福尼亚大学洛杉矶分校活动量表（UCLA）评分为100%。非手术治疗的RTPA率为100%（95%CI：68 - 100），RTS率为86%（95%CI：69 - 94），HHS评分为99（范围96 - 100），骨不连率为18%（95%CI：9 - 34）。所有微小移位患者均接受非手术治疗（RTPA：100%[95%CI：21 - 100]，RTS：100%[95%CI：51 - 100]）。对于严重移位，手术治疗的RTPA和RTS率分别为86%（95%CI：65 - 95）和100%（95%CI：84 - 100），非手术治疗分别为0%（0/1，95%CI：0 - 79）和100%（95%CI：51 - 100）。早期手术的RTPA和RTS率分别为100%（95%CI：34 - 100和57 - 100），而延迟修复分别为（95%CI：72 - 100）和90%（95%CI：60 - 98）。
结论
所有纳入研究均存在较高的偏倚风险。仅有低水平证据，纳入患者数量有限，难以比较手术治疗与非手术治疗的疗效。总体疗效令人满意。基于移位情况存在治疗选择现象，两组疗效均可接受。关于手术时机，数据不足，无法得出结论。
证据级别
IV级。
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