非手术与手术修复急性闭合性跟腱断裂的Meta分析

Acute closed rupture of the Achilles tendon: a Meta-analysis of nonsurgical and surgical treatment

背景:关于非手术及手术修复急性跟腱断裂一直存在争议,相关研究多为回顾性分析,缺乏高等级循证医学证据。目的:系统评价非手术与手术修复急性闭合性跟腱断裂临床疗效。方法:计算机检索Pub Med、EMbase、The Cochrane Library(2014年第1期)、CBM、CNKI、Ovid及Wan Fang Data,手工检索相关杂志,检索时限均从建库或建刊至2014年2月,纳入非手术治疗与手术治疗急性闭合性跟腱断裂的随机对照试验,由2名研究人员独立提取文献数据及质量评价后,用Rev Man 5.2软件进行系统评价。结果与结论:最终纳入9篇随机对照文献,患者共874例,非手术组441例,手术组433例。Meta分析结果显示,与手术组相比较,非手术组总的并发症率更低[OR=0.41,95%CI(0.26,0.63),P<0.000 1],但跟腱再断裂率高[OR=2.86,95%CI(1.62,5.02),P=0.000 2],瘢痕粘连=0.07,95%CI(0.03,0.19),P<0.000 1]。而两者在患者满意度、浅表感染、恢复正常运动、深部感染等方面,差异均无显著性意义(P>0.05)。非手术修复与手术修复急性闭合性跟腱断裂相比,可有效降低总的并发症及瘢痕粘连率,但跟腱再断裂率较高。受样本量及方法质量学的限制,以上结论需要更多大样本、多中心、高质量的随机对照试验验证。

BACKGROUND： There is always a controversy about nonsurgical and surgical repair of acute Achilles tendon rupture. Except retrospective analysis, there is a lack of high-level evidence-based medicine data. OBJECTIVE： To systemically evaluate the clinical effectiveness of the nonsurgical versus surgical treatment for acute closed rupture of the Achilles tendon. METHODS： The randomized controlled trials about the nonsurgical versus surgical treatment for acute Achilles tendon rupture were searched in PubMed, EMbase, CBM, CNKI, Ovid, and WanFang Data by computer as well as in relevant journals by hand, which were reported before February 2014. The Cochrane Library （Issue 1,2014） was also retrieved. Two reviewers independently screened studies, extracted data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Then Meta-analysis was conducted using RevMan 5.2 Software. RESULTS AND CONCLUSION： Nine randomized controlled trials were included, and totally 874 patients were involved, 441 cases in the nonsurgical group and 433 in the surgical group. The results of Meta-analysis showed that compared with the surgical group, the incidence of complications was lower [OR=0.41, 95%CI（0.26, 0.63）, P 〈 0.000 1], but the rate of tendon re-rupture [OR=2.86, 95%CI（1.62, 5.02）, P=0.000 2] and incidence of cicetricial adhesion [OR=0.07, 95%CI（0.03, 0.19）, P 〈 0.000 1] were higher in the nonsurgicat group. However, there were no significant differences between the two groups in patient satisfaction, superficial infection, motion recovery, and deep infection. Compared with the surgical treatment, the nonsurgical treatment can reduce the incidence of complications, but has a higher incidence of re-rupture. Because of sample-size and methodological quality restrictions, this conclusion needs further verification of large-sample, multicenter, and high-quality randomized controlled trials.