Early Functional Treatment Versus Cast Immobilization in Tension After Achilles Rupture Repair: Results of a Prospective Randomized Trial With 10 or More Years of Follow-up
Early Functional Treatment Versus Cast Immobilization in Tension After Achilles Rupture Repair: Results of a Prospective Randomized Trial With 10 or More Years of Follow-up
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DOI：
10.1177/0363546515591267
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发表时间：
2015-09-01
影响因子：
4.8
通讯作者：
Leppilahti, Juhana
中科院分区：
文献类型：
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作者：
Lantto, Iikka;Heikkinen, Juuso;Leppilahti, Juhana
背景：没有长期前瞻性对照试验比较跟腱断裂修复术后的术后方案。目的：比较跟腱断裂修复术后 2 种术后方案（早期负重早期活动与早期负重早期张力固定）的 10 年结果。证据级别，1.方法：共有 50 名急性跟腱断裂患者术后随机接受踝关节在支具中在中立位和跖屈之间进行早期运动 6 周（第 1 组）或使用膝下石膏固定跟腱张力，踝关节处于中立位 6 周（第 2 组）。患者在术后 3、6、14 个月和 11 年进行评估。结果：有 37 名患者 (74%) 在平均 (SD) 为 11.0 +/- 0.9 年时进行了评估。第 1 组的平均 Leppilahti 评分为 92.9 +/- 5.6，第 2 组的平均 Leppilahti 评分为 93.6 +/- 7.2 (P = .68)。平均等速跖屈峰值扭矩不足或跖屈的平均功不足显示任何角速度组之间没有差异。与未受影响的脚踝相比，等速力量在 1 至 11 年间变化很小，但 11 年后仍然存在峰值扭矩平均不足 5% 和平均做功平均不足 8%。相反，等长跖屈力量显着恢复，11年随访时仅相差2.4%。结论：11年随访后，跟腱断裂修复术后早期活动和张力固定具有相似的临床结果和等速力量。无论患者对手术治疗的满意度如何，小腿肌肉力量即使在11年的随访中也没有恢复正常。
Background: There are no long-term prospective controlled trials comparing postoperative regimens after Achilles tendon rupture repair.Purpose: To compare 10-year outcomes of 2 postoperative regimens after Achilles tendon rupture repair: early weightbearing with early mobilization versus early weightbearing with early immobilization in tension.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: A total of 50 patients with acute Achilles tendon ruptures were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for 6 weeks (group 1) or Achilles tendon immobilization in tension using a below-knee cast with the ankle in a neutral position for 6 weeks (group 2). Patients were assessed at 3, 6, and 14 months and 11 years postoperatively.Results: There were 37 patients (74%) evaluated at a mean (SD) of 11.0 +/- 0.9 years. The mean Leppilahti score was 92.9 +/- 5.6 in group 1 and 93.6 +/- 7.2 in group 2 (P = .68). The mean isokinetic plantar flexion peak torque deficits or average work deficits in plantar flexion showed no differences between the groups with any angular velocity. Isokinetic strength changed minimally between 1 and 11 years compared with the unaffected ankle, but a mean deficit of 5% in peak torque and mean deficit of 8% in average work were still present after 11 years. On the contrary, isometric plantar flexion strength recovered significantly, with only a 2.4% difference at 11-year follow-up.Conclusion: After the 11-year follow-up, early mobilization and immobilization in tension after Achilles rupture repair resulted in similar clinical outcomes and isokinetic strengths. Regardless of patient satisfaction with the operative treatment, calf muscle strength did not recover normally even at 11-year follow-up.