前两天看到一篇好文章，今天给大家分享一下（或许你们也看到过）。这篇文章给骨科医生一个信息：不是跟腱断裂的患者都需要手术修复。下面看这篇文章吧：
JBJS:多中心随机对照研究应用加速功能康复方案（非手术）治疗新鲜的跟腱断裂，各临床结果均与手术组相似，并可避免手术相关并发症。
这篇文章来自加拿大Fowler Kennedy Sport Medicine Clinic，发表于美国的“ The Journal of Bone and Joint Surgery ”杂志上。
论文题目：Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation.
J Bone Joint Surg Am. 2010;92:2767-2775.

Background:To date,studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair.Published studies of animals and humans have shown a benefit of early functional stimulus to healing tendons.The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with operative repair and accelerated
functional rehabilitation with the outcomes of similar patients treated with accelerated functional rehabilitation alone.

背景：目前对于跟腱断裂（Achilles tendon rupture）的患者，采用手术治疗还是非手术治疗依然没有定论，但是手术治疗会带来相关的并发症。基于动物与人的试验论文中，早期功能刺激（early functional stimulus）能愈合肌腱的修复。下面这篇文章的目的就是要对比手术治疗（手术修复）与非手术治疗（加速功能康复方案，accelerated functional rehabilitation）在跟腱断裂疗效的对比。
Methods：patients were randomized to operative or nonoperative treatment for acute Achilles tendon rupture.All patients underwent an accelerated rehabilitation protocol that featured early weight-bearing and early range of motion.The primary outcome was the rerupture rate as demonstrated by a positive Thompson squeeze test,the presence of a palpable gap,and loss of plantar flexion strength.Secondary outcomes included isokinetic strength,the Leppilahti score, range of motion,and calf circumference measured at three,six,twelve,and twenty-four months after injury.

方法：急性跟腱断裂患者被随机分为手术治疗组与非手术治疗组。非手术治疗的患者接受加速康复方案，主要包括：早期负重与早期ROM的练习。跟腱断裂的评估主要是Thompson挤压试验阳性，跟腱触及有凹陷与跖屈肌力。次要评估是在损失后3个月、6个月、12个月和24个月分别测等速肌力，Leppilahti得分，ROM与小腿肌围度的测量。
Results:A total of 144 patients(seventy-two treated operatively and seventy-two treated nonoperatively)were randomized.There were 118 males and twenty-six females,and the mean age(and standard deviation)was 40.4±8.8 years.
Rerupture occurred in two patients in the operative group and in three patients in the nonoperative group.There was no clinically important difference between groups with regard to strength,range of motion,calf circumference,or Leppilahti
score.There were thirteen complications in the operative group and six in the nonoperative group,with the main difference being the greater number of soft-tissue-related complications in the operative group.

结果：144患者（72接受手术治疗，72人接受非手术治疗），其中有118男性和26女性，平均年龄是40.4±8.8 years.
1、 手术治疗中的患者有2人发生跟腱断裂，非手术治疗中的患者有3人发生断裂。
2、 两组患者在肌力、ROM、小腿的肌围度与Leppilahti得分没有明显差别。
3、 手术治疗组存在13种并发症，而非手术治疗组存在6种并发症；手术治疗组主要的并发症是软组织相
关的并发症

 

Conclusions:This study supports accelerated functional rehabilitation and nonoperative treatment for acute Achilles tendon ruptures.All measured outcomes of nonoperative treatment were acceptable and were clinically similar to those
for operative treatment.In addition,this study suggests that the application of an accelerated-rehabilitation nonoperative protocol avoids serious complications related to surgical management.

结论：这篇文章支持对于急性跟腱断裂的患者采用加速功能康复方案与非手术治疗。非手术治疗的效果是比较明显的，并且与手术治疗的效果无差异。另外，该研究说明了加速功能康复方案能避免手术治疗的严重并发症。

转载本文请联系原作者获取授权，同时请注明本文来自王雪强科学网博客。
链接地址：https://blog.sciencenet.cn/blog-506928-392921.html

上一篇：怎么预防髌股关节疼痛综合征？
下一篇：肩峰撞击综合征的五种特殊检查