Nauta Hijleke J A, van der Made Anne D, Tol Johannes L, Reurink Gustaaf, Kerkhoffs Gino M
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.
Knee Surg Sports Traumatol Arthrosc. 2021 Jun;29(6):1813-1821. doi: 10.1007/s00167-020-06222-y. Epub 2020 Aug 18.
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.
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.
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.
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.
IV.
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。
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。
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）。
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。
IV级。
