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Satisfactory clinical outcome of operative and non-operative treatment of avulsion fracture of the hamstring origin with treatment selection based on extent of displacement: a systematic review.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.8 ) Pub Date : 2020-08-18 , DOI: 10.1007/s00167-020-06222-y
Hijleke J A Nauta 1, 2, 3 , Anne D van der Made 1, 2, 3 , Johannes L Tol 1, 2, 3, 4 , Gustaaf Reurink 1, 2, 3 , Gino M Kerkhoffs 1, 2, 3
Affiliation  

Purpose

To compare outcome of operative and non-operative treatment of avulsion fractures of the hamstring origin, with minor (< 1.5 cm) and major (≥ 1.5 cm) displacement, and early (≤ 4 weeks) and delayed (> 4 weeks) surgery.

Methods

A systematic literature search was performed using PubMed, Cochrane, Embase, CINAHL and SPORTDiscus. A quality assessment was performed using the Physiotherapy Evidence Database (PEDro) scale.

Results

Eight studies with 90 patients (mean age: 16 years) were included. All studies had low methodological quality (PEDro score ≤ 5). Operative treatment yielded a return to preinjury activity rate (RTPA) of 87% (95% CI: 68–95), return to sports (RTS) rate of 100% (95% CI: 82–100), Harris hip score (HHS) of 99 (range 96–100) and a University of California Los Angeles activity scale (UCLA) score of 100%. Non-operative treatment yielded a RTPA rate of 100% (95% CI:68–100), RTS rate of 86% (95% CI: 69–94), HHS score of 99 (range 96–100), and non-union rate of 18% (95% CI: 9–34). All patients with minor displacement were treated non-operatively (RTPA: 100% [95% CI: 21–100], RTS: 100% [95% CI: 51–100]). For major displacement, operative treatment led to RTPA and RTS rates of 86% (95% CI: 65–95) and 100% (95% CI: 84–100), and 0% (0/1, 95% CI: 0–79) and 100% (95% CI: 51–100) for non-operative treatment. Early surgery yielded RTPA and RTS rates of 100% (95% CI: 34–100 & 57–100) compared to 100 (95% CI: 72–100) and 90% (95% CI: 60–98) for delayed repair.

Conclusion

All included studies have high risk of bias. There is only low level of evidence with a limited number of included patients to compare outcome of operative and non-operative treatment. Overall outcome was satisfactory. There is a treatment selection phenomenon based on displacement, with acceptable outcome in both groups. There is insufficient data to draw conclusions regarding timing of surgery.

Level of evidence

IV



中文翻译:

根据移位程度选择治疗方法,对腿筋源性撕脱性骨折进行手术和非手术治疗的临床效果令人满意:系统评价。

目的

为了比较小腿(<1.5 cm)和大(≥1.5 cm)移位,早期(≤4周)和延迟(> 4周)手术的the绳肌撕脱性骨折的手术和非手术治疗结果。

方法

使用PubMed,Cochrane,Embase,CINAHL和SPORTDiscus进行了系统的文献检索。使用物理疗法证据数据库(PEDro)量表进行了质量评估。

结果

纳入了八项针对90名患者的研究(平均年龄:16岁)。所有研究的方法学质量均较低(PEDro评分≤5)。手术治疗的伤前恢复率(RTPA)为87%(95%CI:68–95),运动恢复(RTS)为100%(95%CI:82–100),哈里斯髋关节评分(HHS) )(99分(范围96-100))和加州大学洛杉矶分校的活动量表(UCLA)得分为100%。非手术治疗的RTPA率为100%(95%CI:68-100),RTS率为86%(95%CI:69-94),HHS评分为99(范围96-100),工会率18%(95%CI:9-34)。所有患有轻度移位的患者均未经手术治疗(RTPA:100%[95%CI:21-100],RTS:100%[95%CI:51-100])。对于大位移,手术治疗导致RTPA和RTS发生率分别为86%(95%CI:65–95)和100%(95%CI:84–100)和0%(0/1,95%CI:0-79)和100%(95%CI:51-100)用于非手术治疗。早期手术产生的RTPA和RTS率为100%(95%CI:34-100和57-100),而延迟修复为100(95%CI:72-100)和90%(95%CI:60-98) 。

结论

所有纳入的研究都有偏见的高风险。只有很少的证据表明,纳入的患者数量有限,无法比较手术和非手术治疗的结果。总体结果令人满意。存在基于位移的治疗选择现象,两组均可接受。没有足够的数据得出有关手术时间的结论。

证据水平

IV

更新日期:2020-08-18
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