非手術治療對於阿基里斯腱的斷裂可能是最好的


2003年9月25日—根據一篇發表於9月10月號American Journal of Sports Medicine的回顧性群組研究結果顯示,阿基里斯腱斷裂透過非手術方式治療可能是最好的。
  
  瑞士伯爾尼大學的Martin Weber博士表示,阿基里斯腱的急性封閉性斷裂最好的治療方法一直倍受爭議,新型的非手術治療概念已經展現出良好的治療結果,而且有可接受的併發症發生率,擁護手術的人表示,手術可以得到較佳的修補效果,更快速地復原,而且再度斷裂的發生率較低。
  
  這項研究比較23名以equinus腳踝固定敷料和矯正靴進行非手術治療的患者,並且與24名進行手術的患者一起比較治療結果,二組患者的肌肉增強和全身重量步行的之承受度均一致,研究人員繼續追蹤18個非手術治療的患者23個月,以及15名手術治療患者49個月。
  
  非手術治療的組比手術治療組的病情進展更佳,其獨立步行和回去上班的時間也較快,患者的滿意度、恢復運動和最後的力量在二組間並無不同。
  
  儘管大多數併發症比率在二組間是相似的,但是在非手術組中,有四個早期復發的病例,在手術組中只有一位患者於晚期復發,在非手術組中,再度斷裂可分為二種類型,當正常痊癒的腱受到新創傷時,在痊癒區域再度斷裂,而且繼續以非手術方式治療的結果良好。但是,當腱斷裂於非舊傷區域,而是在最初斷裂的肌腱匯合處發生斷裂,這種類型的再斷裂需要手術修補。
  
  研究限制包括回顧的本質、連續的群組比較,以及治療後程序的些微差異,根據我們的程序,非手術治療的阿基里斯腱急性封閉性斷裂患者有實質的效果,而且其併發症可媲美手術患者,但是還需要更大規模的研究更精確地評估阿基里斯腱急性封閉性斷裂的治療。
  

Nonsurgical Treatment May Be B

By Laurie Barclay, MD
Medscape Medical News

Sept. 25, 2003 — Nonsurgical treatment of Achilles tendon rupture may be best, according to the results of a retrospective cohort study published in the September-October issue of the American Journal of Sports Medicine.

"The best method of treatment for acute closed ruptures of the Achilles tendon continues to be debated," write Martin Weber, MD, from the University of Bern in Switzerland, and colleagues. "Modern concepts of nonoperative treatment have been shown to produce good results with acceptable complication rates. Advocates of operative treatment claim to obtain a stronger repair with a faster rehabilitation and better ultimate strength, with fewer reruptures."

This study compared the outcome of 23 patients treated nonsurgically with an equinus ankle cast and boot with that of 24 patients who previously underwent surgical repair. Both groups received muscle strengthening and walking with full weight-bearing as soon as tolerated in both groups. Follow-up examinations were performed for 18 nonsurgically treated patients after 23 months and for 15 surgically treated patients after 49 months.

The nonsurgically treated group fared better than the surgically treated group in terms of faster pain relief, return to unaided walking, and return to work. Patient satisfaction, return to sports, and ultimate strength did not differ between groups.

Although the rate of most complications was similar in both groups, there were four early reruptures in the nonoperative group and one late rerupture in the operative group. In the nonoperative group, reruptures were of two types. When the normally healing tendon was subjected to new trauma, it reruptured in the healing zone and responded well to continued nonoperative treatment. However, when the tendon failed proximal to the initial rupture at the muscle-tendon junction, without trauma, this type of rerupture required surgical repair and augmentation.

Study limitations include retrospective nature, the comparison of sequential groups, and slight differences in aftertreatment protocols.

"Patients with an acute closed rupture of the Achilles tendon treated nonoperatively according to our protocol had functional results and a rate of complications comparable with those of an earlier similar group of patients treated operatively," the authors write. "A larger-scale controlled trial would allow us to more precisely define the value of the tendon suture in the treatment of acute closed ruptures of the Achilles tendon."

The authors report no financial benefit to themselves or to their institutions related to this study.

Am J Sports Med. 2003;31:685-691

Reviewed by Gary D. Vogin, MD

    
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