挪威阿克斯胡斯大学医院Ståle B. Myhrvold团队比较了急性跟腱断裂的非手术或外科治疗的效果。该项研究成果发表在2022年4月13日出版的《新英格兰医学杂志》上。

通过开放式修复或微创方法对急性跟腱断裂进行手术修复，是否比非手术治疗效果更好，目前尚不明确。

研究组进行了一项多中心、随机、对照试验，比较了在四个试验中心就诊的成人急性跟腱断裂患者的非手术治疗、开放式修复和微创手术。主要结局是12个月时跟腱总断裂评分（0到100分，评分越高表明健康状况越好）与基线检查相比的变化。次要结局包括肌腱再断裂的发生率。

共有554名患者接受了随机分组，526名被纳入最终分析。非手术组跟腱总断裂评分与基线相比的平均变化为17.0分，开放式修复组平均变化为16.0分，微创手术组平均变化为14.7分。两两比较没有证据表明各组之间存在显著差异。三组患者的身体表现和患者报告的身体功能与基线检查时的变化相似。非手术组肌腱再断裂的患者比例（6.2%）显著高于开放式修复组或微创手术组（各0.6%）。微创手术组有9例神经损伤（占5.2%），开放式修复组有5例（占2.8%），非手术组有1例（占0.6%）。

研究结果表明，对于跟腱断裂的患者，手术（开放式修复或微创手术）在12个月时与非手术治疗相比没有显著提升疗效。

附：英文原文

Title: Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture

Author: Stle B. Myhrvold, M.D.,, Espen F. Brouwer, M.D.,, Tor K. M. Andresen, M.D.,, Karin Rydevik, P.T., M.Sc.,, Madeleine Amundsen, M.D.,, Wolfram Grün, M.D.,, Faisal Butt, M.D.,, Morten Valberg, Ph.D.,, Svend Ulstein, M.D., Ph.D.,, and Sigurd E. Hoelsbrekken, M.D., Ph.D.

Issue&Volume: 2022-04-13

Abstract:

Background

Whether surgical repair of an acute Achilles’ tendon rupture by an open-repair or minimally invasive approach is associated with better outcomes than nonsurgical treatment is not clear.

Methods

We performed a multicenter, randomized, controlled trial that compared nonoperative treatment, open repair, and minimally invasive surgery in adults with acute Achilles’ tendon rupture who presented to four trial centers. The primary outcome was the change from baseline in the Achilles’ tendon Total Rupture Score (scores range from 0 to 100, with higher scores indicating better health status) at 12 months. Secondary outcomes included the incidence of tendon rerupture.

Results

A total of 554 patients underwent randomization, and 526 patients were included in the final analysis. The mean changes in the Achilles’ tendon Total Rupture Score were 17.0 points in the nonoperative group, 16.0 points in the open-repair group, and 14.7 points in the minimally invasive surgery group (P=0.57). Pairwise comparisons provided no evidence of differences between the groups. The changes from baseline in physical performance and patient-reported physical function were similar in the three groups. The number of tendon reruptures was higher in the nonoperative group (6.2%) than in the open-repair or minimally invasive surgery group (0.6% in each). There were 9 nerve injuries in the minimally invasive surgery group (in 5.2% of the patients) as compared with 5 in the open-repair group (in 2.8%) and 1 in the nonoperative group (in 0.6%).

Conclusions

In patients with Achilles’ tendon rupture, surgery (open repair or minimally invasive surgery) was not associated with better outcomes than nonoperative treatment at 12 months.

DOI: 10.1056/NEJMoa2108447

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2108447