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

doi:10.3969/j.issn.2095-4344.2015.15.029

Abstract

Abstract:

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 cicatricial adhesion [OR=0.07, 95%CI(0.03, 0.19), P < 0.000 1] were higher in the nonsurgical 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.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Achilles Tendon, Tendon Injuries, Infection, Cicatrix

CLC Number:

R318

Chen Ke-yi, Cao Wan-jun, Zhang Meng-yuan. Acute closed rupture of the Achilles tendon: a Meta-analysis of nonsurgical and surgical treatment[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(15): 2449-2454.

Figures/Tables 3

2.3 Meta分析结果患者满意度：2篇文献报道了患者满意度[5，7]，共纳入患者128例，非手术组59例，手术组69例。各研究间无统计学异质性(P=0.76，I2=0%) I2 < 50%，故采用固定效应模型进行系统评价。Meta分析结果示，非手术组在患者满意度方面与手术组疗效差异无显著性意义[OR=0.79，95%CI(0.43，1.43)，P=0.43]。见图2。恢复正常运动：4篇文献报道了恢复正常运动[4-5，7，9]，共纳入患者211例，非手术组97例，手术组114例。各研究间有统计学异质性(P=0.03，I2=68%) I2> 50%，故采用随机效应模型进行系统评价，异质性来源多与各研究中没有统一描述恢复正常运动标准有关。Meta分析结果示，非手术组在恢复正常运动方面与手术组疗效差异无显著性意义[OR=0.75，95%CI (0.49，1.14)，P=0.18]。见图3。总的并发症：7篇文献报道了总的并发症[4，5，7-10，12]，共纳入患者723例，非手术组357例，手术组366例。各研究间有统计学异质性(P=0.002，I2=71%) I2 > 50%，故采用随机效应模型进行系统评价，异质性来源无法分析，固对各并发症行亚组分析。Meta分析结果示，非手术组在总的并发症方面少于手术组，两组差异有显著性意义[OR=0.41，95%CI (0.26，0.63)，P < 0.000 1]。见图4。跟腱再断裂：9篇文献报道了跟腱再断裂[3-5，7-11，12]，共纳入患者874例，非手术组441例，手术组433例。各研究间无统计学异质性(P=0.54，I2=0%) I2< 50%，故采用固定效应模型进行系统评价。Meta分析结果示，非手术组患者跟腱再断裂方面高于手术组，两组差异有显著性意义[OR=2.86，95%CI(1.63，5.02)，P=0.000 2]。见图5。浅表感染：5篇文献报道了浅表感染[5，8-10，12]，共纳入患者480例，非手术组212例，手术组268例。各研究间无统计学异质性(P=0.93，I2=0%) I2 < 50%，故采用固定效应模型进行系统评价。Meta分析结果示，两组差异无显著性意义[OR=0.22，95%CI(0.05，1.02)，P=0.05]。见图6。深部感染：6篇文献报道了深部感染[3，4，7-10]，共纳入患者620例，非手术组317例，手术组303例。各研究间无统计学异质性(P=0.62，I2=0%) I2 < 50%，故采用固定效应模型进行系统评价。Meta分析结果示，两组差异无显著性意义[OR=0.48，95%CI(0.15，1.54)，P=0.22]。见图7。瘢痕粘连：6篇文献报道了瘢痕粘连[3-5，7，8，10]，共纳入患者652例，非手术组329例，手术组323例。各研究间无统计学异质性(P=0.03，I2=17%) I2 < 50%，故采用固定效应模型进行系统评价。Meta分析结果示，非手术组在瘢痕粘连方面少于手术组，两组差异有显著性意义[OR=0.07，95%CI (0.03，0.19)，P < 0.000 01]。见图8。"

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