手术与保守治疗急性闭合性跟腱断裂的Meta分析  

Effect of operation versus conservative treatment for acute closed Achilles tendon rupture: a Meta analysis

作　　者：熊小龙[1] 王和驹[1] 马心赤[1] 邱勋永[1] 林崇正[1] 王快胜[1] 张燕翔[1] 陈汉东[1] 曾德斌[1] 周钢[1] 

机构地区：[1]海南省人民医院骨三科,海南海口570311

出　　处：《海南医学》2013年第4期590-595,共6页Hainan Medical Journal

摘　　要：目的对手术与保守治疗急性闭合性跟腱断裂的疗效进行系统评价。方法计算机检索MEDLINE(1966年至2012年3月)、EMBASE(1966年至2012年3月)、Cochrane图书馆(2012年1月)及中国生物医学文献数据库(1979年至2011年12月),并手工检索相关的中英文骨科杂志。收集所有相关的随机对照试验,并评价纳入研究的方法学质量,按照Cochrane协作网推荐的方法对跟腱断裂治疗后的再断裂率、并发症发生率及伤口感染率进行评价。结果分析显示:(1)再断裂率:开放手术显著低于保守治疗,开放手术与经皮缝合差异无统计学意义,术后石膏固定与术后功能治疗差异无统计学意义,保守石膏固定与保守功能治疗差异无统计学意义。(2)并发症发生率:保守治疗与经皮缝合显著低于开放手术,术后功能治疗显著低于术后石膏固定,保守石膏固定与保守功能治疗差异无统计学意义。(3)伤口感染率:保守治疗与经皮缝合显著低于开放手术,术后石膏固定与术后功能治疗差异无统计学意义。结论开放手术再断裂发生率低于保守治疗,但并发症发生率和伤口感染率高于经皮缝合与保守治疗。术后功能治疗的并发症发生率显著低于术后石膏固定。但因研究质量的局限性,经皮手术与保守治疗的关系有待进一步研究。Objective To compare the efficacy and safety of operation with conservative treatment for acute Achilles tendon rupture. Methods Randomised controlled trials were collected from Medline （from 1966 to March 2012）, Embase （from 1966 to March 2012）, Cochrane Library （Jan. 2012） and CBM disc （from 1979 to December, 2011）, and relevant Chinese and English orthopedic journals. The quality of trials was critically assessed. The rempture rate, the in- cidences of complications and wound infection were assessed by using the method recommended by the Cochrane Collaboration. Results （1） The rempture rate showed no statistically significant difference between open operation and conservative treatment, open operation and percutaneous treatment, postoperative piaster fixation and postoperative functional treatment, conservative piaster fixation and conservative functional treatment. （2） The incidence of complications was significantly lower in conservative treatment and percutaneous treatment than open operation, in postoperative functional treat- ment than postoperative plaster fixation, but showed no statistically significant difference between conservative plaster fixation and conservative fimctional treatment. （3） The incidence of wound infection was significantly lower in conservative treatments and percutaneous treatment than open operation, but showed no statistically significant difference between postoperative plaster fixation and postoperative functional treatment. Conclusion For acute Achilles tendon ruptures, open operation results in a lower rerupture rate compared with conservative treatment, but higher incidences of complications and wound infection than percutaneous treatment and conservative treatment. Postoperative functional treatment has a lower incidence of complications than postoperative plaster fixation. Owing to the limits of the quality of the trials, the relation between percutaneous treatment and conservative treatment still needs further study.

关 键 词：急性跟腱断裂 闭合 治疗 随机对照试验 系统评价 META分析 

分 类 号：R68[医药卫生—骨科学]