目的:手术与保守治疗急性跟腱断裂的效果仍存在争议。这项研究的目的是比较手术和保守治疗在最低随访1年的并发症。功能结果和临床结果。
目的:并发症无差异,两个治疗组之间的临床结果和功能结局。由于固定或康复方案,并发症的发生或临床结果没有差异。
方法:这是一个回顾性比较,多中心,2018-01-01-2019-31-12法国21个研究中心急性跟腱断裂的非随机研究.纳入所有接受手术或保守治疗的患者。人口统计,体育参与,治疗的性质,固定参数(类型,持续时间,位置)和康复方案被收集。喷发,一般和特定的并发症,临床结果(脚跟上升试验,单腿跳,小腿周长,踝关节背屈)和功能结果(ATRS,VISA-A,EFAS,SF-12)在最终审查时收集。
结果:在平均24(±7)个月的随访中,对四百五个患者进行了回顾。手术治疗372例(92%),保守治疗33例(8%)。这两组患者具有相当的术前特征。保守组的破裂次数相似(3例,9%)与手术组(15例,4%)(p=0.176)。保守组(24%)的一般并发症多于手术组(11%)(p=0.04)。手术相关并发症的发生率为9%(感染,神经损伤,麻醉后效应)。ATRS(p=0.017),EFAS总计(p=0.013),EFAS日常生活(p=0.008),和SF-12物理(p=0.01)在手术组中更好。严格然后相对固定提供了功能恢复(EFAS总计33,p<0.01)和肌腱延长(0°,p=0.01)而不增加再破裂的发生(2%,p=0.18)。与超过30天开始的情况相比,早期负重并伴有固定和康复并不会导致更多的破裂(p=0.082和p=0.07)。
结论:本研究发现急性跟腱断裂的手术治疗和保守治疗在断裂次数上没有差异。手术治疗可获得更好的临床效果,但对改善功能评分具有可变作用。无论使用哪种治疗方法,在理想的情况下,在马蹄严格固定3周之后,应在接下来的3周内逐渐减少。在30天内早期负重和动员并没有增加再破裂的风险;它实际上优化了临床和功能结果。
方法:III;回顾性比较,非随机化。
OBJECTIVE: The results of surgical versus conservative treatment of acute Achilles tendon ruptures are still controversial. The objective of this study was to compare surgical and conservative treatment at a minimum follow-up of 1 year in terms of the complications, functional outcomes and clinical results.
OBJECTIVE: There is no difference in the complications, clinical results and functional outcomes between the two treatment groups. There is no difference in the occurrence of complications or the clinical results due to the immobilization or rehabilitation protocols.
METHODS: This was a retrospective comparative, multicenter, non-randomized study of acute Achilles tendon ruptures treated between 01/01/2018 and 31/12/2019 at 21 study sites in France. All patients who received surgical or conservative treatment were included. The demographics, sports participation, nature of treatment, immobilization parameters (type, duration, position) and rehabilitation protocol were collected. Rerupture, general and specific complications, clinical results (heel-rise test, single-leg hop, calf circumference, ankle dorsiflexion) and the functional outcomes (ATRS, VISA-A, EFAS, SF-12) were collected at the final review.
RESULTS: Four hundred five patients were reviewed at a mean follow-up of 24 (±7) months. Surgical treatment was done in 372 patients (92%) and conservative treatment in 33 patients (8%), with these two sets of patients having comparable preoperative characteristics. There was a similar number of reruptures in the conservative group (3 cases, 9%) as in the surgical group (15 cases, 4%) (p=0.176). There were more general complications in the conservative group (24%) than in the surgical group (11%) (p=0.04). There was a 9% rate of surgery-related complications (infection, nerve damage, anesthesia after-effects). The ATRS (p=0.017), EFAS Total (p=0.013), EFAS daily living (p=0.008), and SF-12 physical (p=0.01) were better in the surgical group. Strict then relative immobilization provided the best balance between functional recovery (EFAS total of 33, p<0.01) and tendon lengthening (0°, p=0.01) without increasing the occurrence of rerupture (2%, p=0.18). Early weightbearing accompanied by immobilization and rehabilitation within 30 days did not lead to more reruptures than if it was started beyond 30 days (p=0.082 and p=0.07).
CONCLUSIONS: This study found no differences in the number of reruptures between surgical treatment and conservative treatment of acute Achilles tendon ruptures. Surgical treatment led to better clinical results but had a variable effect on improving the functional scores. No matter which treatment is used, in the ideal case, 3 weeks of strict immobilization in equinus should be followed by progressive reduction over the next 3 weeks. Early weightbearing and mobilization within 30 days did not increase the risk of rerupture; it actually optimized the clinical and functional outcomes.
METHODS: III; retrospective comparative, non-randomized.