摘要目的 比较加强缝合与直接缝合的疗效，为急性跟腱断裂修复的手术方式选择提供循证依据。 方法 系统检索PubMed、 Web of Science、EMBASE、知网及万方数据库中加强缝合对比直接缝合治疗急性跟腱断裂的研究，检索时限为1990年1月 — 2019年1月，按照预先设定的纳入及排除标准筛选，并参照Cochrane系统评价手册及纽卡斯尔-渥太华量表(NOS)严格进行文献质量评价。应用RevMan 5.3软件分析，比较加缝合或直接缝合治疗急性跟腱断裂在患者满意度、再断裂率、感染率、踝关节活动度、其他并发症（术后小腿萎缩程度、跖屈度、跖屈力量）方面差异有无统计学意义。 结果 最终纳入8篇文献，共558例患者，其中加强缝合组273例，直接缝合组285例。患者对加强缝合与直接缝合的满意度相近（OR=1.00，95% CI 0.54～1.84，P>0.05）。 再断裂率显示加强缝合与直接缝合差异无统计学意义（OR=0.75，95% CI 0.34～1.66,P>0.05）。两种手术方式对感染率（OR=1.73，95% CI 0.76～3.94,P>0.05）、踝关节活动度(OR=0.97，95% CI 0.33～2.87，P>0.05)及其他并发症发生率(OR=1.93，95% CI 0.91～4.09，P>0.05)的影响差异无统计学意义（P＞0.05）。加强缝合与直接缝合对术后小腿萎缩、小腿平均等速跖屈力量影响差异无统计学意义（P＞0.05）；加强缝合术后患肢的跖屈度较健侧降低（P<0.05）。 结论 与直接缝合相比，加强缝合治疗急性跟腱断裂并不能提高患者满意度或降低并发症发生率。
Abstract：Objective To compare the efficacy of augmentation suture and direct suture in treatment of acute Achilles tendon ruptures so as to provide evidences for the selection of surgical methods. Methods A systematic search was conducted in PubMed, Web of Science, EMBASE, CNKI and Wanfang database for studies of augmentation suture versus direct suture of acute Achilles tendon ruptures. Literatures were retrieved from January 1990 to January 2019. Literatures were screened according to the pre-set inclusion and exclusion criteria, and the rating of included literature was strictly evaluated by the Cochrane System Evaluation Manual and Newcastle Ottawa scale (NOS). The relevant data were analyzed using RevMan 5.3 to compare patient satisfaction, rerupture rate, infection rate, ankles range of motion and other complications (postoperative calf atrophy, plantar flexion, plantar flexion strength). Results Eight articles involving 558 patients were identified including 273 patients in augmentation suture group and 285 patients in direct suture group.There were no significant differences between two groups in aspects of patient satisfaction (OR=1.00, 95% CI 0.54-1.84, P>0.05), rerupture rate (OR=0.75，95% CI 0.34-1.66, P>0.05), infection rate (OR=1.73, 95% CI 0.76-3.94, P>0.05), ankles range of motion (OR=0.97, 95% CI 0.33-2.87, P>0.05) and other complications rate (OR=1.93, 95% CI 0.91-4.09, P>0.05). Meantime, the two groups showed similar effect on postoperative calf atrophy and average isokinetic calf muscle strength (P>0.05). There was a significant difference in plantar flexion of injured limbs after augmentation suture（P<0.05）. Conclusion Compared with direct suture, augmentation suture cannot improve patient satisfaction or reduce complication rate in repair of acute Achilles tendon ruptures.
黄凌岸 李鹏翠 王春芳 卫小春. 加强缝合与直接缝合治疗急性跟腱断裂疗效的Meta分析[J]. 中华创伤杂志, 2020, 36(7): 637-642.
Huang Lingan, Li Pengcui, Wang Chunfang, Wei Xiaochun.. Efficacy of augmentation versus direct suture for repairing acute Achilles tendon ruptures：a Metaanalysis. CHINESE JOURNAL OF TRAUMA, 2020, 36(7): 637-642.
