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Re: Разрыв ахиллова сухожилия.
послал Alexander Chelnokov 10 Январь 2004, 13:39
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AB> Вопросы:
AB> 1. Как часто встречали Вы данную ситуацию в своей практике?
Как-то в наших краях то ли не принято вводить гормоны в эту область,
то ли просто не попадались, но разрывы идут "обычные".
AB> 2. Можно ли достоверно говорить об осложнении лечения ГКС?
Во всяком случае, есть статьи типа нижепривеженной (тоже три случая :-):
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Swiss Surg. 2001;7(4):184-9.
[Rupture of the Achilles tendon after local steroid injection.
Case reports and consequences for treatment]
[Article in German]
Csizy M, Hintermann B.
Orthopadische Universitatsklinik Basel, Felix Platter-Spital. mcsizy@hotmail.com
It is known that Steroids increase the risk for tendon ruptures.
Despite this local steroids are still used in the treatment of
achilles tendinitis. Three cases are demonstrated. All of them
show an unusual rupture mechanism. Intraoperatively necrotic
tendon changes are seen. All patients receive an open tendon
reconstruction with healthy, autologous material. Although there
is a delayed healing in one case, all patients show favourable
results one year postoperatively with return to full range
activity levels and are able to participate in sports.
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AB> 3. Стоит ли не рекомендовать своим сотрудникам вводить ГКС при ахиллобурситах?
Соттветственно. Вот еще реферат мета-анализа, предупреждающего об этой
опасности:
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Clin J Sport Med. 1996 Oct;6(4):245-50.
Comment in:
Clin J Sport Med. 1996 Oct;6(4):218-9.
Achilles tendonitis: are corticosteroid injections useful or harmful?
Shrier I, Matheson GO, Kohl HW 3rd.
Herzl Family Practice Centre, Department of Family Medicine, McGill University,
Montreal, Quebec, Canada.
OBJECTIVE: The use of local corticosteroid injections for the treatment of Achilles tendonitis is controversial. Some authors advocate their use based on efficacy in accelerating the healing process of Achilles tendonitis; others feel the associated side effects should preclude their use altogether. The purpose of this study was to comprehensively review and critically appraise the available literature in order to examine the evidence concerning this clinical dilemma.
DATA SOURCES: MEDLINE was searched using MeSH and textwords for English- and French-language articles related to Achilles tendonitis and corticosteroids published since 1966. Additional references were reviewed from the bibliographies of the retrieved articles. The total number of articles reviewed was 145.
STUDY SELECTION: All clinical study designs were included as well as related animal studies using experimental and quasi-experimental designs.
DATA EXTRACTION AND SYNTHESIS: In reviewing the literature, particular attention was paid to the relative strengths of the different study designs. From these data, the factors associated with effectiveness and safety of injected corticosteroids were examined.
MAIN RESULTS: The only rigorous studies (one randomized controlled trial, one cohort study) showed no benefit of corticosteroids over placebo. In animal studies, corticosteroid injections decrease adhesion formation, temporarily weaken the tendon if given intratendinously, but have no effect on tendon strength if injected into the paratenon. The overall incidence of side effects with locally injected corticosteroids is approximately 1%. Most side effects are temporary, but skin atrophy and depigmentation can be permanent. Although there are many case reports of Achilles tendon rupture following local corticosteroid injection, there are no published rigorous studies that evaluate the risk of rupture with or without corticosteroid injection. CONCLUSIONS: There are insufficient published data to determine the comparative risks and benefits of corticosteroid injections in Achilles tendonitis. The decreased tendon strength with intratendinous injections in animal studies suggests that rupture may be a potential complication for several weeks following injection.
Publication Types:
Meta-Analysis
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