一项随机对照试验,评估急性腘绳肌腱近端撕脱手术修复后的无支架和加速负重方案

Dr Jay Ebert, Dr Peter Edwards, Dr Steven Cecchi, Mr Randeep Aujla, Mr Peter Annear, Mr Brendan Ricciardo, Mr Peter D’Alessandro
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引用次数: 0

摘要

膕绳肌近端肌腱从骶骨结节处撕脱是一种严重损伤,建议进行手术修复。术后,关于最佳康复方案的数据有限,已公布的方案也存在很大差异。本研究调查了腘绳肌腱近端修复术后传统保守(CR)康复方案与加速(AR)康复方案的患者疗效。 这项前瞻性随机对照试验(RCT)将 50 名接受腘绳肌腱近端修复术的患者分配到有支撑、部分负重的康复治疗方案(CR=25)或加速、无支撑、可在耐受情况下完全负重的康复治疗方案(AR=25)中。患者在术前、术后3个月、6个月和12个月时接受评估,评估采用患者报告的结果指标(PROMs),包括下肢功能量表(LEFS)、珀斯腘绳肌评估工具(PHAT)和12项简表健康调查(SF-12)。在 6 个月和 12 个月时,对单次(SHD)、三次(THD)和三次交叉(TCHD)跳跃测试进行了评估,同时还评估了腘绳肌肌力峰值和膝关节伸屈扭力峰值。 所有 PROMs 均有所改善(P>0.05),虽然 AR 组在 3 个月时 SF-12 物理成分得分显著提高(P=0.022),并且在 12 个月时腿筋疼痛的严重程度降低(P=0.032),但其他组别没有差异。各组之间的腘绳肌等长力量峰值、等动股四头肌和腘绳肌扭矩对称性峰值均具有可比性(P>0.05)。虽然 AR 组在 6 个月后的 THD 中表现出明显更好的肢体对称性(p=0.009),但各组之间在其他跳跃测试中未见差异。已观察到三次再次损伤(CR=2,AR=1)。 腘绳肌近端修复手术后,采用加速康复疗法的术后效果与传统保守疗法基本相当。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A RANDOMIZED CONTROLLED TRIAL ASSESSING A BRACE-FREE AND ACCELERATED WEIGHT-BEARING PROTOCOL AFTER SURGICAL REPAIR OF ACUTE PROXIMAL HAMSTRING TENDON AVULSIONS
Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair advocated. After surgery, limited data exists regarding the optimal rehabilitation regime with extensive variation in published protocols. This study investigated patient outcomes following a traditionally conservative (CR) versus accelerated (AR) rehabilitation regimen after proximal hamstring tendon repair. This prospective randomized controlled trial (RCT) allocated 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25). Patients were evaluated pre-operatively and at 3, 6 and 12 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). The single (SHD), triple (THD) and triple crossover (TCHD) hop tests were assessed at 6 and 12 months, as was peak isometric hamstring strength and peak isokinetic knee extensor and flexor torque. All PROMs improved (p>0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), as well as a lower severity of hamstring pain at 12 months (p=0.032), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p>0.05). While the AR group demonstrated significantly better (p=0.009) limb symmetry for the THD at 6 months, no other hop test differences were seen between groups. Three re-injuries have been observed (CR=2, AR=1). After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen were largely comparable to a traditionally conservative
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