Cho Thomas, Nair Ajay, Sohn Elisabeth, Mustapha Rayanne, Shendge Shradha, Liu Jiayong
Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA.
Ann Jt. 2025 Apr 21;10:11. doi: 10.21037/aoj-24-53. eCollection 2025.
The Achilles tendon rupture is a common injury of the lower extremity, inducing pain and physical impairment. Surgical treatment methods include open, percutaneous, and mini-open repair techniques. This study aims to compare the outcomes of these three techniques.
PubMed, Google Scholar, and EMBASE were searched until November 2023. Randomized controlled trials (RCT) and retrospective comparative studies (RCS) comparing either open versus percutaneous repair, open versus mini-open repair, or percutaneous mini-open repair of the Achilles tendon rupture were included with at least one of the following outcomes: American Orthopedic Foot & Ankle Society (AOFAS) score, Achilles Tendon Total Rupture Score (ATRS) score, re-ruptures, sural nerve injuries, infections, wound dehiscence, deep vein thrombosis (DVT), and average operating time. Meta-analysis was mostly processed by RevMan 5. A P value of ≤0.05 was considered statistically significant. Risk of bias was assessed with RevMan 5 and the Newcastle-Ottawa scale.
Twenty-six studies, including 1,898 patients, were included. The percutaneous group had significantly more sural nerve injuries [risk ratio (RR) =0.28; 95% confidence interval (CI): 0.14 to 0.57; P<0.001], fewer infections (RR =2.99; 95% CI: 1.37 to 6.49; P=0.006), higher AOFAS score [standardized mean difference (SMD) =-0.32; 95% CI: -0.61 to -0.03; P=0.03], higher ATRS (SMD =-0.24; 95% CI: -0.47 to -0.02; P=0.03), and a shorter average operating period (SMD =2.29; 95% CI: 1.63 to 2.96; P<0.001) than the open repair group. The mini-open group had a significantly higher AOFAS score (SMD =-0.58; 95% CI: -1.06 to -0.09; P=0.02), higher ATRS (SMD =-0.65; 95% CI: -1.05 to -0.26; P=0.001), longer average operating time (SMD =-0.95; 95% CI: -1.46 to -0.45; P<0.001), and lower rates of re-ruptures and sural nerve injuries than the percutaneous group. The open group had significantly more infections than the mini-open group (RR =2.99; 95% CI: 1.07 to 8.37; P=0.04).
The mini-open repair technique demonstrated superior function scores and lower complication rates than percutaneous repair and open repair. It should be the first choice when treating Achilles tendon ruptures, with percutaneous repair being a reliable alternative.
跟腱断裂是下肢常见损伤，会导致疼痛和身体功能障碍。手术治疗方法包括开放修复、经皮修复和微创开放修复技术。本研究旨在比较这三种技术的治疗效果。
检索截至2023年11月的PubMed、谷歌学术和EMBASE数据库。纳入比较跟腱断裂开放修复与经皮修复、开放修复与微创开放修复或经皮与微创开放修复的随机对照试验（RCT）和回顾性比较研究（RCS），至少具备以下一项结果：美国矫形足踝协会（AOFAS）评分、跟腱完全断裂评分（ATRS）、再断裂、腓肠神经损伤、感染、伤口裂开、深静脉血栓形成（DVT）以及平均手术时间。荟萃分析主要通过RevMan 5软件进行。P值≤0.05被认为具有统计学意义。使用RevMan 5软件和纽卡斯尔 - 渥太华量表评估偏倚风险。
共纳入26项研究，涉及1898例患者。与开放修复组相比，经皮修复组腓肠神经损伤显著更多[风险比（RR）=0.28；95%置信区间（CI）：0.14至0.57；P<0.001]，感染更少（RR =2.99；95% CI：1.37至6.49；P=0.006），AOFAS评分更高[标准化均值差（SMD）=-0.32；95% CI：-0.61至-0.03；P=0.03]，ATRS更高（SMD =-0.24；95% CI：-0.47至-0.02；P=0.03），平均手术时间更短（SMD =-2.29；95% CI：-1.63至-2.96；P<0.001）。微创开放组AOFAS评分显著更高（SMD =-0.58；95% CI：-1.06至-0.09；P=0.02），ATRS更高（SMD =-0.65；95% CI：-1.05至-0.26；P=0.001），平均手术时间更长（SMD =-0.95；95% CI：-1.46至-0.45；P<0.001），再断裂和腓肠神经损伤发生率低于经皮修复组。开放组感染显著多于微创开放组（RR =2.99；95% CI：1.07至8.37；P=0.04）。
与经皮修复和开放修复相比，微创开放修复技术显示出更好的功能评分和更低的并发症发生率。治疗跟腱断裂时，微创开放修复技术应作为首选，经皮修复是一种可靠的替代方法。
