中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
6期
493-499
,共7页
陈江涛%荀传辉%宋兴华%加莎热特·杰力勒%霍建军
陳江濤%荀傳輝%宋興華%加莎熱特·傑力勒%霍建軍
진강도%순전휘%송흥화%가사열특·걸력륵%곽건군
跟腱%软组织损伤%功能恢复%Meta分析
跟腱%軟組織損傷%功能恢複%Meta分析
근건%연조직손상%공능회복%Meta분석
Achilles tendon%Soft tissue injuries%Recovery of function%Meta-analysis
目的 对急性跟腱断裂术后早期功能锻炼与制动的疗效进行Meta分析. 方法 按照Cochrane系统评价方法,计算机检索MEDLINE(1966年至2011年1月)、EMbase(1966年至2011年1月),Cochrane图书馆(2011年第1期)、Cochrane协作网肌骨创伤组试验数据库(2011年1月)和中国生物医学文献数据库(1978年1月至2011年1月),手工检索中文骨科期刊的相关文献(创刊至2011年1月),收集急性跟腱断裂术后早期功能锻炼与制动的所有相关随机对照试验(RCTs)及半随机对照试验(CCTs),提取有效数据采用RevMan 4.2.8进行Meta分析,以比较急性跟腱断裂术后早期功能锻炼与制动的术后满意率、跟腱再次断裂发生率、感染率、并发症发生率、术后6周跟腱延长率、术后12周跟腱延长度的评价、小腿肌力、踝关节活动度的差异.结果 共纳入4个RCTs,3个CCTs.Meta分析显示,与术后制动相比,急性跟腱断裂术后早期功能锻炼的满意率增加(RR=1.27,95％ CI(1.01,1.61),P=0.04),术后并发症发生率降低[RR =0.43,95％ CI (0.22,0.83),P=0.01],差异有统计学意义；而两种方法术后跟腱再次断裂发生率[RR=0.59,95％ CI (0.20,1.80),P=0.92]、术后感染率[RR=0.70,95％ CI (0.26,1.86),P=0.48]、术后6周[SMD=1.50,95％ CI(-3.40,6.40)]和12周跟腱延长度[SMD=- 0.25,95％ CI(- 5.64,5.14)l及踝关节活动度无显著差异. 结论 与术后制动相比,急性跟腱断裂术后早期功能锻炼提高患者满意率,降低并发症发生率,且不会增加跟腱再次断裂和感染的风险,对术后6周和12周跟腱延长度、小腿肌力和踝关节活动度无明显影响.
目的 對急性跟腱斷裂術後早期功能鍛煉與製動的療效進行Meta分析. 方法 按照Cochrane繫統評價方法,計算機檢索MEDLINE(1966年至2011年1月)、EMbase(1966年至2011年1月),Cochrane圖書館(2011年第1期)、Cochrane協作網肌骨創傷組試驗數據庫(2011年1月)和中國生物醫學文獻數據庫(1978年1月至2011年1月),手工檢索中文骨科期刊的相關文獻(創刊至2011年1月),收集急性跟腱斷裂術後早期功能鍛煉與製動的所有相關隨機對照試驗(RCTs)及半隨機對照試驗(CCTs),提取有效數據採用RevMan 4.2.8進行Meta分析,以比較急性跟腱斷裂術後早期功能鍛煉與製動的術後滿意率、跟腱再次斷裂髮生率、感染率、併髮癥髮生率、術後6週跟腱延長率、術後12週跟腱延長度的評價、小腿肌力、踝關節活動度的差異.結果 共納入4箇RCTs,3箇CCTs.Meta分析顯示,與術後製動相比,急性跟腱斷裂術後早期功能鍛煉的滿意率增加(RR=1.27,95％ CI(1.01,1.61),P=0.04),術後併髮癥髮生率降低[RR =0.43,95％ CI (0.22,0.83),P=0.01],差異有統計學意義；而兩種方法術後跟腱再次斷裂髮生率[RR=0.59,95％ CI (0.20,1.80),P=0.92]、術後感染率[RR=0.70,95％ CI (0.26,1.86),P=0.48]、術後6週[SMD=1.50,95％ CI(-3.40,6.40)]和12週跟腱延長度[SMD=- 0.25,95％ CI(- 5.64,5.14)l及踝關節活動度無顯著差異. 結論 與術後製動相比,急性跟腱斷裂術後早期功能鍛煉提高患者滿意率,降低併髮癥髮生率,且不會增加跟腱再次斷裂和感染的風險,對術後6週和12週跟腱延長度、小腿肌力和踝關節活動度無明顯影響.
목적 대급성근건단렬술후조기공능단련여제동적료효진행Meta분석. 방법 안조Cochrane계통평개방법,계산궤검색MEDLINE(1966년지2011년1월)、EMbase(1966년지2011년1월),Cochrane도서관(2011년제1기)、Cochrane협작망기골창상조시험수거고(2011년1월)화중국생물의학문헌수거고(1978년1월지2011년1월),수공검색중문골과기간적상관문헌(창간지2011년1월),수집급성근건단렬술후조기공능단련여제동적소유상관수궤대조시험(RCTs)급반수궤대조시험(CCTs),제취유효수거채용RevMan 4.2.8진행Meta분석,이비교급성근건단렬술후조기공능단련여제동적술후만의솔、근건재차단렬발생솔、감염솔、병발증발생솔、술후6주근건연장솔、술후12주근건연장도적평개、소퇴기력、과관절활동도적차이.결과 공납입4개RCTs,3개CCTs.Meta분석현시,여술후제동상비,급성근건단렬술후조기공능단련적만의솔증가(RR=1.27,95％ CI(1.01,1.61),P=0.04),술후병발증발생솔강저[RR =0.43,95％ CI (0.22,0.83),P=0.01],차이유통계학의의；이량충방법술후근건재차단렬발생솔[RR=0.59,95％ CI (0.20,1.80),P=0.92]、술후감염솔[RR=0.70,95％ CI (0.26,1.86),P=0.48]、술후6주[SMD=1.50,95％ CI(-3.40,6.40)]화12주근건연장도[SMD=- 0.25,95％ CI(- 5.64,5.14)l급과관절활동도무현저차이. 결론 여술후제동상비,급성근건단렬술후조기공능단련제고환자만의솔,강저병발증발생솔,차불회증가근건재차단렬화감염적풍험,대술후6주화12주근건연장도、소퇴기력화과관절활동도무명현영향.
Objective To evaluate the effectiveness of early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures.Methods Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures were identified from MEDLINE (from 1966 to 2011.1),EMBASE (from 1966 to 2011.1),Cochrane Library (Issue 1,2011),Cochrane Musculoskeletal Injuries Group Database (2011.1) and CBM disc (from 1979 to 2011.1).We hand-searched Chinese Journal of Orthopaedics (from the llrst issue to January issue,2011 ) and Chinese Journal of Orthopaedic Trauma (from the first issue to January issue,2011 ) for RCTs and CCTs of our interest.Data were extracted by 2 reviewers with designed extraction form.RevMan 4.2.8 software was used for data analysis.Results Four RCTs and 3 CCTs were included for the present meta analysis.Compared with postoperative immobilization,early functional rehabilitation significantly improved patients' subjective satisfaction [ RR =1.27,95％ CI (1.01,1.61),P =0.04]and reduced the complication rate [ RR =0.43,95％ CI (0.22,0.83),P =0.01 ]but did not significantly increase the rerupture rate [ RR =0.59,95％ CI (0.20,1.80),P =0.92],the infection rate [ RR =0.70,95％ CI (0.26,1.86),P =0.48],or the achilles elongation at either 6 weeks [SMD=1.50,95％ CI(-3.40,6.40)]or at 12 weeks[SMD=-0.25,95％ CI(-5.64,5.14)].Conclusions Compared with postoperative immobilization for acute achilles tendon ruptures,early functional rehabilitation can obviously increase patients' subjective satisfaction and reduce complications without increasing risks of rerupture and infection.There is no significant difference in achilles elongation,calf strength and range of motion of the ankle between the 2 treatments.
