前瞻性随机对照研究：改良经皮跟腱修复术后局部麻醉下早期负重功能支具固定与刚性固定的比较。

Prospective randomized comparison of functional bracing versus rigid immobilization with early weightbearing after modified percutaneous achilles tendon repair under local anesthesia.

机构信息

Department of Traumatology, Clinic for Surgery, University Clinical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia.

出版信息

Foot (Edinb). 2024 Sep;60:102124. doi: 10.1016/j.foot.2024.102124. Epub 2024 Aug 27.

DOI:10.1016/j.foot.2024.102124

PMID:39190962

Abstract

OBJECTIVE

The optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia.

METHODS

In a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29-71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29-57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed.

RESULTS

There was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters.

CONCLUSION

Early dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol.

LEVEL OF EVIDENCE

I, Prospective randomized study.

摘要

目的

急性跟腱断裂（ATR）的最佳治疗和康复策略仍存在争议。本研究旨在比较局部麻醉下改良闭合经皮修复治疗 ATR 后两种术后方案的结果。

方法

在一项为期 4 年的研究中，72 例急性完全性 ATR 患者在经皮修复后随机分为功能组（FG）和固定组（IG）。FG 使用改良支具（28 名男性，3 名女性；平均年龄 41.9[29-71]岁），IG 使用刚性石膏（28 名男性，2 名女性；平均年龄 42.2[29-57]岁），固定 6 周。除固定外，他们遵循相同的负重和康复方案。随访时间为 3 年。评估并发症发生率、主动和被动踝关节活动范围、站立足跟抬高试验、美国足踝外科协会（AOFAS）后足-踝关节评分的临床结果、恢复到以前的活动水平以及主观评估。

结果

IG 中有 1 例再断裂，FG 中有 2 例短暂性腓肠神经紊乱和 1 例 IG 中有 1 例缝线挤出，无其他并发症。FG 和 IG 的平均 AOFAS 评分为 96.9±4.3 和 96.0±4.9。FG 组患者更快地达到最终的活动范围和肌肉力量，且无跛行，对治疗更满意。在任何评估参数中，两组之间的结果均无显著差异。