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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Is Operative Treatment of Achilles Tendon Ruptures Superior to Nonoperative Treatment?
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Is Operative Treatment of Achilles Tendon Ruptures Superior to Nonoperative Treatment?

机译：跟腱断裂的手术治疗是否优于非手术治疗？

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Background: Multiple meta-analyses have been published in efforts to determine whether operative or nonoperative treatment of Achilles tendon ruptures affords superior outcomes. Purpose: To perform a systematic review of overlapping meta-analyses comparing operative and nonoperative treatment of Achilles tendon ruptures to determine which meta-analyses provide the highest level of evidence for treatment recommendations. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the literature was performed to identify meta-analyses that fit the study inclusion criteria. Data were extracted from these meta-analyses regarding patient outcomes and reruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and QUOROM (Quality of Reporting of Meta-analyses) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence. Results: Nine meta-analyses met the eligibility criteria, with all but 1 study including level 1 evidence. A total of 5842 patients were included. Seven studies found a higher rate of rerupture in the nonoperative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and 1 study found surgery decreased rerupture rates only when compared with nonoperative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 of 9) of the meta-analyses had Oxman-Guyatt scores >3, indicating no major flaws. Conclusion: Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared with nonoperative treatment. Additionally, surgical treatment may allow earlier return to work.
机译：背景：已经发表了多项荟萃分析，以努力确定跟腱断裂的手术或非手术治疗是否可获得更好的疗效。目的：对重叠的荟萃分析进行系统评价，比较跟腱断裂的手术和非手术治疗，以确定哪些荟萃分析可为治疗建议提供最高水平的证据。研究设计：系统评价;证据等级，3。方法：对文献进行系统的审查，以确定符合研究纳入标准的荟萃分析。从这些荟萃分析中提取有关患者预后和复发的数据。荟萃分析的质量使用Oxman-Guyatt和QUOROM（荟萃分析的报告质量）系统进行评估。使用Jadad算法确定证据水平最高的荟萃分析。结果：9项荟萃分析符合资格标准，除1项研究外，所有研究均包括1级证据。包括5842名患者。七项研究发现，非手术组的复发率较高，但手术组的并发症发生率较高。一项研究发现，在复发或并发症发生率方面没有差异，并且一项研究发现，只有在与无功能性支架的非手术治疗相比时，手术才能降低复发率。三项研究还确定了手术组较早返回工作岗位的情况。几乎所有荟萃分析（9个中的8个）的Oxman-Guyatt得分均> 3，表明没有重大缺陷。结论：与非手术治疗相比，跟腱断裂的手术治疗降低了复发率，但增加了轻微并发症的风险。另外，手术治疗可以允许较早恢复工作。

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