■近端腿筋撕脱伤(PHAI)的手术结果有很好的记录,然而,与非手术方法的比较分析仍然很少。
■比较PHAI手术和非手术干预的功能结果。
■队列研究;证据水平,3.
■这项比较研究,2012年1月至2021年7月在运动手术中心进行,重点是原发性PHAI患者。该研究是对前瞻性收集数据的回顾性分析。组选择涉及使用倾向评分匹配来比较手术治疗的患者的手臂(适应症包括患有完全损伤的患者,>2cm回缩的部分损伤患者,和6个月非手术治疗失败的患者)与另一支拒绝手术的患者。使用巴黎腿筋撕脱评分(PHAS)评估主要结果。次要结果包括Tegner活动量表(TAS)评分;加州大学,洛杉矶(UCLA)得分;重返运动的比率和质量(RTS);和患者满意度。
■该研究包括32名患者(平均年龄,55.8年[SD,8.4岁])在非手术治疗组中,95例患者在手术治疗组中(平均年龄,53.4年[SD,7.7年])(P>.05)。从损伤到治疗的间隔为5.7个月(SD,9.6个月),手术组12.7个月(SD,非手术组25.9个月)(P>.05)。在最后一次随访中(非手术组:平均,56.5个月[SD,28.2个月];手术组:平均值,50.7个月[SD,33.1个月]),手术组的PHAS明显更高(平均值,86.3[SD,13.7])与非手术组(平均值,69.8[SD,15.1])(P<.0001)。在TAS和UCLA评分的手术组中也观察到更高的活动评分(分别为P=.0224和P=.0026)。手术组(68.4%)恢复运动的比例高于非手术组(46.9%)(P=0.0354),手术组中返回相同或更高水平的比例更大(67.7%vs26.7%)(P=.0069)。此外,手术组(89.5%)患者的满意度高于非手术组(25%)(P<0.0001).手术组中的三名患者出现了并发症(阴部神经区域2次破裂和1次感觉过敏)。赔率比(OR)表明,手术组的患者更有可能达到或超过PHAS的中位数得分(OR,6.79;P<.001),TAS评分(或,2.29;P=.045),和UCLA得分(或,3.63;P=.003),以及任何级别的RTS(或,2.46;P=.031)或在损伤前水平或更高(OR,6.04;P<.001)。
■这项研究表明,PHAI的手术治疗显着提高了长期功能评分,包括PHAS,TAS评分,加州大学洛杉矶分校得分,满意,和RTS,与非手术治疗相比,平均随访时间>4年。
■NCT02906865(ClinicalTrials.gov标识符)。
UNASSIGNED: Surgical outcomes for proximal hamstring avulsion injury (PHAI) are well documented, yet comparative analyses with nonsurgical approaches remain scarce.
UNASSIGNED: To compare the functional outcomes between surgical and nonsurgical interventions for PHAI.
UNASSIGNED: Cohort
study; Level of evidence, 3.
UNASSIGNED: This comparative
study, conducted at a sports surgery center between January 2012 and July 2021, focused on patients with primary PHAI. The
study was a retrospective analysis of prospectively collected data. Group selection involved utilizing propensity score matching to compare an arm of patients who were surgically treated (indications included patients with complete injury, patients with partial injury with >2 cm of retraction, and patients for whom 6 months of nonsurgical treatment failed) with another arm of patients who refused surgery. The primary outcome was evaluated using the Parisian Hamstring Avulsion Score (PHAS). The secondary outcomes included the Tegner Activity Scale (TAS) score; University of California, Los Angeles (UCLA) score; rate and quality of return to sport (RTS); and patient satisfaction.
UNASSIGNED: The
study included 32 patients (mean age, 55.8 years [SD, 8.4 years]) in the nonsurgical treatment arm and 95 patients in the surgical treatment arm (mean age, 53.4 years [SD, 7.7 years]) (P > .05). The interval from injury to treatment was 5.7 months (SD, 9.6 months) for the surgical group and 12.7 months (SD, 25.9 months) for the nonsurgical group (P > .05). At the final follow-up (nonsurgical group: mean, 56.5 months [SD, 28.2 months]; surgical group: mean, 50.7 months [SD, 33.1 months]), the PHAS was significantly higher in the surgical group (mean, 86.3 [SD, 13.7]) compared with the nonsurgical group (mean, 69.8 [SD, 15.1]) (P < .0001). Higher activity scores were also observed in the surgical group for the TAS and UCLA scores (P = .0224 and P = .0026, respectively). A higher percentage of the surgical group (68.4%) returned to sports compared with the nonsurgical group (46.9%) (P = .0354), with a greater proportion in the surgical group returning at the same or higher level (67.7% vs 26.7%) (P = .0069). Additionally, a higher satisfaction level was reported by patients in the surgical group (89.5%) in contrast to the nonsurgical group (25%) (P < .0001). Three patients in the surgical group experienced complications (2 reruptures and 1 hyperesthesia at the pudendal nerve territories). Odds ratios (ORs) indicated that patients in the surgical group were significantly more likely to achieve or exceed median scores for the PHAS (OR, 6.79; P < .001), TAS score (OR, 2.29; P = .045), and UCLA score (OR, 3.63; P = .003), as well as to RTS at any level (OR, 2.46; P = .031) or at the preinjury level or higher (OR, 6.04; P < .001).
UNASSIGNED: This
study demonstrated that surgical treatment of PHAI significantly enhances long-term functional scores, including the PHAS, TAS score, UCLA score, satisfaction, and RTS, at a mean follow-up of >4 years compared with nonsurgical treatment.
UNASSIGNED: NCT02906865 (ClinicalTrials.gov identifier).