Background:Surgical outcomes for proximal hamstring avulsion injury (PHAI) are well documented, yet comparative analyses with nonsurgical approaches remain scarce.Purpose:To compare the functional outcomes between surgical and nonsurgical interventions for PHAI.Study Design:Cohort study; Level of evidence, 3.Methods:This comparative study, conducted at a sports surgery center between January 2012 and July 2021, focused on patients with primary PHAI. The study was a retrospective analysis of prospectively collected data. Group selection involved utilizing propensity score matching to compare an arm of patients who were surgically treated (indications included patients with complete injury, patients with partial injury with >2 cm of retraction, and patients for whom 6 months of nonsurgical treatment failed) with another arm of patients who refused surgery. The primary outcome was evaluated using the Parisian Hamstring Avulsion Score (PHAS). The secondary outcomes included the Tegner Activity Scale (TAS) score; University of California, Los Angeles (UCLA) score; rate and quality of return to sport (RTS); and patient satisfaction.Results:The study included 32 patients (mean age, 55.8 years [SD, 8.4 years]) in the nonsurgical treatment arm and 95 patients in the surgical treatment arm (mean age, 53.4 years [SD, 7.7 years]) ( P > .05). The interval from injury to treatment was 5.7 months (SD, 9.6 months) for the surgical group and 12.7 months (SD, 25.9 months) for the nonsurgical group ( P > .05). At the final follow-up (nonsurgical group: mean, 56.5 months [SD, 28.2 months]; surgical group: mean, 50.7 months [SD, 33.1 months]), the PHAS was significantly higher in the surgical group (mean, 86.3 [SD, 13.7]) compared with the nonsurgical group (mean, 69.8 [SD, 15.1]) ( P < .0001). Higher activity scores were also observed in the surgical group for the TAS and UCLA scores ( P = .0224 and P = .0026, respectively). A higher percentage of the surgical group (68.4%) returned to sports compared with the nonsurgical group (46.9%) ( P = .0354), with a greater proportion in the surgical group returning at the same or higher level (67.7% vs 26.7%) ( P = .0069). Additionally, a higher satisfaction level was reported by patients in the surgical group (89.5%) in contrast to the nonsurgical group (25%) ( P < .0001). Three patients in the surgical group experienced complications (2 reruptures and 1 hyperesthesia at the pudendal nerve territories). Odds ratios (ORs) indicated that patients in the surgical group were significantly more likely to achieve or exceed median scores for the PHAS (OR, 6.79; P < .001), TAS score (OR, 2.29; P = .045), and UCLA score (OR, 3.63; P = .003), as well as to RTS at any level (OR, 2.46; P = .031) or at the preinjury level or higher (OR, 6.04; P < .001).Conclusion:This study demonstrated that surgical treatment of PHAI significantly enhances long-term functional scores, including the PHAS, TAS score, UCLA score, satisfaction, and RTS, at a mean follow-up of >4 years compared with nonsurgical treatment.Registration:NCT02906865 (ClinicalTrials.gov identifier)

中文翻译：

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近端腘绳肌撕脱伤的手术治疗与非手术治疗相比：近端腘绳肌撕脱手术队列研究的平均随访时间 > 4 年的匹配比较研究


背景：近端腿筋撕脱伤 (PHAI) 的手术结果已有详细记录，但与非手术方法的比较分析仍然很少。目的：比较手术和非手术干预治疗 PHAI 的功能结果。证据级别，3。方法：这项比较研究于 2012 年 1 月至 2021 年 7 月在运动外科中心进行，重点关注原发性 PHAI 患者。该研究是对前瞻性收集的数据的回顾性分析。分组选择涉及利用倾向评分匹配来比较一组接受手术治疗的患者（适应症包括完全损伤的患者、部分损伤且回缩>2厘米的患者以及6个月非手术治疗失败的患者）与另一组拒绝手术的患者。主要结果使用巴黎腿筋撕脱评分（PHAS）进行评估。次要结果包括泰格纳活动量表（TAS）评分；加州大学洛杉矶分校（UCLA）成绩；重返运动的比率和质量（RTS）；结果：该研究包括非手术治疗组的 32 名患者（平均年龄，55.8 岁 [SD，8.4 岁]）和手术治疗组的 95 名患者（平均年龄，53.4 岁 [SD，7.7 岁]） ( P > .05)。手术组从受伤到接受治疗的时间间隔为 5.7 个月（SD，9.6 个月），非手术组为 12.7 个月（SD，25.9 个月）（ P > .05）。在最后一次随访时（非手术组：平均 56.5 个月 [SD，28.2 个月]；手术组：平均 50.7 个月 [SD，33.1 个月]），手术组的 PHAS 显着更高（平均 86.3 [SD，33.1 个月]） SD，13.7]）与非手术组（平均值，69.8 [SD，15.1]）相比（P < .0001）。手术组的 TAS 和 UCLA 评分也有较高的活动评分（分别为 P = .0224 和 P = .0026）。与非手术组 (46.9%) 相比，手术组 (68.4%) 恢复运动的比例更高 (P = .0354)，手术组中恢复运动水平相同或更高的比例更高 (67.7% vs 26.7%) %) (P = .0069)。此外，与非手术组 (25%) 相比，手术组患者 (89.5%) 的满意度更高 ( P < .0001)。手术组中有 3 名患者出现并发症（2 例阴部神经区域再断裂和 1 例感觉过敏）。比值比 (OR) 表明，手术组患者达到或超过 PHAS 中值评分（OR，6.79；P < .001）、TAS 评分（OR，2.29；P = .045）和UCLA 评分（OR，3.63；P = .003），以及任何水平的 RTS（OR，2.46；P = .031）或受伤前水平或更高水平（OR，6.04；P < .001）。结论：本研究表明，与非手术治疗相比，PHAI 的手术治疗可显着提高长期功能评分，包括 PHAS、TAS 评分、UCLA 评分、满意度和 RTS，平均随访时间 > 4 年。注册：NCT02906865 （临床试验。政府标识符）