开放、经皮或小开放修复治疗跟腱断裂的比较:基于比较研究的系统回顾和荟萃分析

IF 0.5 4区 医学 Q4 ORTHOPEDICS
Annals of Joint Pub Date : 2025-04-21 eCollection Date: 2025-01-01 DOI:10.21037/aoj-24-53
Thomas Cho, Ajay Nair, Elisabeth Sohn, Rayanne Mustapha, Shradha Shendge, Jiayong Liu
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引用次数: 0

摘要

背景:跟腱断裂是一种常见的下肢损伤,可引起疼痛和肢体损伤。手术治疗方法包括开放、经皮和小开放修复技术。本研究旨在比较这三种技术的结果。方法:检索PubMed、谷歌Scholar和EMBASE,检索截止日期为2023年11月。随机对照试验(RCT)和回顾性比较研究(RCS)比较开放与经皮修复,开放与小开放修复,或经皮与小开放修复的跟腱断裂,包括至少一个以下结果:美国骨科足踝学会(AOFAS)评分、跟腱总断裂评分(ATRS)评分、再断裂、腓肠神经损伤、感染、伤口开裂、深静脉血栓形成(DVT)和平均手术时间。meta分析主要采用RevMan 5进行。P值≤0.05认为有统计学意义。采用RevMan 5和Newcastle-Ottawa量表评估偏倚风险。结果:纳入26项研究,包括1898例患者。经皮组腓肠神经损伤明显多于经皮组[危险比(RR) =0.28;95%置信区间(CI): 0.14 ~ 0.57;结论:与经皮修复和开放式修复相比,微型开放式修复技术具有更高的功能评分和更低的并发症发生率。它应该是治疗跟腱断裂的首选,经皮修复是一种可靠的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of open, percutaneous, or mini-open repair in the treatment of Achilles tendon ruptures: a systematic review and meta-analysis based on comparison studies.

Background: 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.

Methods: 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 vs. 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.

Results: 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).

Conclusions: 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.

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Annals of Joint
Annals of Joint ORTHOPEDICS-
CiteScore
1.10
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