内窥镜与开放手术治疗插入性跟腱病：比较结果的系统回顾和荟萃分析

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-24 DOI:10.1002/jeo2.70374

Po-Yuan Chen, I-Shiang Tzeng, Kai-Chiang Yang, Chen-Chie Wang

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引用次数: 0

摘要

目的插入性跟腱病（IAT）引起慢性后足疼痛和功能损害。虽然保守治疗仍然是一线治疗方法，但当非手术措施失败时，手术往往是必要的。开放和内窥镜技术都是常用的，但它们的相对疗效仍有争议。因此，本荟萃分析比较了开放和内窥镜技术的手术结果、并发症和恢复情况；它还进行了一项亚组分析，以评估高度活跃的个体重返运动的情况。方法系统检索PubMed、Cochrane Library、Scopus、ScienceDirect、Web of Science和Embase数据库（2003-2024）的文献。≥20例患者且随访≥6个月的开放或内窥镜IAT手术结果纳入研究。结果包括美国骨科足踝协会（AOFAS）评分、恢复运动时间、并发症发生率和其他功能结果测量。结果纳入39项研究（1559例患者，1625例手术）。平均AOFAS评分从56.07分提高到89.17分（p < 0.001），不同手术方式间无显著差异（p = 0.18）。然而，内窥镜手术并发症发生率较低，恢复较快，能够更早地恢复日常活动（6.75±2.25周对22.45±4.74周，p < 0.001）和运动（12.63±2.2周对22.13±7.42周，p < 0.001）。在高度活跃的个体中，内窥镜手术有助于在12-18个月内恢复运动，而开放手术需要20-30个月。结论内镜手术并发症发生率低，恢复快，是需要早期恢复活动的患者的首选手术方式。需要更多高质量的研究，如随机对照试验和标准化方案，以改善IAT的手术决策和治疗策略。证据等级四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Endoscopic versus open surgery for insertional achilles tendinopathy: A systematic review and meta-analysis of comparative outcomes

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Endoscopic versus open surgery for insertional achilles tendinopathy: A systematic review and meta-analysis of comparative outcomes

Purpose

Insertional Achilles tendinopathy (IAT) causes chronic hindfoot pain and functional impairment. Although conservative treatment remains the first-line management approach, surgery is often necessary when nonoperative measures fail. Both open and endoscopic techniques are commonly used, but their comparative efficacy remains debated. Accordingly, this meta-analysis compared surgical outcomes, complications and recovery between open and endoscopic techniques; it also conducted a subgroup analysis to assess return to sports in highly active individuals.

Methods

A systematic literature search was conducted in PubMed, the Cochrane Library, Scopus, ScienceDirect, Web of Science and Embase (2003–2024). Studies were included if they reported outcomes for open or endoscopic IAT surgery with ≥20 patients and ≥6 months of follow-up. Outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) scores, time to return to sports, complication rates and additional functional outcome measures.

Results

Thirty-nine studies (1559 patients, 1625 procedures) were included. Mean AOFAS scores improved from 56.07 to 89.17 (p < 0.001), with no significant difference between surgical techniques (p = 0.18). However, endoscopic surgery was associated with a lower complication rate and faster recovery, enabling earlier return to daily activities (6.75 ± 2.25 vs. 22.45 ± 4.74 weeks, p < 0.001) and sports (12.63 ± 2.2 vs. 22.13 ± 7.42 weeks, p < 0.001). Among highly active individuals, endoscopic surgery facilitated return to sports within 12–18 months, whereas open surgery required 20–30 months.

Conclusions

Endoscopic surgery demonstrates a low complication rate and expedited recovery, making it a preferable option for patients requiring an early return to activity. More high-quality studies, such as randomized controlled trials and standardized protocols, are needed to improve surgical decisions and treatment strategies for IAT.