Van Der Windt D A, Van Der Heijden G J, Van Den Berg S G, Ter Riet G, De Winter A F, Bouter L M
Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit, Van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT.
Cochrane Database Syst Rev. 2000(2):CD001250. doi: 10.1002/14651858.CD001250.
Ultrasound is used in the treatment of a wide variety of musculoskeletal disorders.
To evaluate the effects of ultrasound therapy in the treatment of acute ankle sprains.
MEDLINE and EMBASE up to December 1998 and databases of the Cochrane Rehabilitation and Related Therapies Field and Musculoskeletal Injuries Group were searched. This was supplemented with citation tracking, and contact with colleagues. Date of the most recent search: April 1999.
Randomised or pseudo-randomised trials were included in the review if the following conditions were met: at least one study group was treated with active ultrasound; the study included patients with acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Final selection of papers was conducted by two independent reviewers.
Two reviewers independently assessed trial quality using a standardised checklist, and extracted data. Whenever possible, the results were analysed on an intention-to-treat basis. Fixed odds ratios together with 95% confidence intervals were calculated for dichotomous outcomes, and weighted or, where different scales were used, standardised mean differences together with 95% confidence intervals for continuous outcome measures. Pooling of data was undertaken where there was clinical homogeneity in terms of subjects, treatments, outcomes, and follow-up time points.
The four included trials, involving 514 patients, were only of modest methodological quality. None of the three placebo-controlled trials (sham ultrasound) could demonstrate statistically significant differences between true and sham ultrasound therapy for any outcome measure at seven days of follow-up. The pooled odds ratio for general improvement was 1.19 (Peto fixed effects model, 95% confidence interval 0.73 to 1.93) for the comparison between ultrasound and sham ultrasound. The differences between intervention groups were generally small, between 0 and 6% for most dichotomous outcomes. However, one trial reported relatively large differences for pain free status (20%) and swelling (25%) in favour of ultrasound treatment.
REVIEWER'S CONCLUSIONS: The extent and quality of the available evidence for the effects of ultrasound therapy for acute ankle sprains are limited. The results of three placebo-controlled trials do not support the use of ultrasound in the treatment of ankle sprains. The magnitude of most reported treatment effects appeared to be small, and may be of limited clinical importance. As yet, only few trials are available and no conclusions can be made regarding an optimal and adequate dosage schedule for ultrasound therapy, and whether such a schedule would improve on the reported effectiveness of ultrasound for ankle sprains.
超声被用于治疗多种肌肉骨骼疾病。
评估超声治疗急性踝关节扭伤的效果。
检索了截至1998年12月的MEDLINE和EMBASE数据库，以及Cochrane康复及相关治疗领域和肌肉骨骼损伤小组的数据库。并通过引文追踪及与同事联系进行补充。最近一次检索日期为1999年4月。
若符合以下条件，随机或半随机试验将被纳入本综述：至少有一个研究组接受了主动超声治疗；研究纳入了急性外侧踝关节扭伤患者；结局指标包括总体改善情况、疼痛、肿胀、功能障碍或活动范围。最终论文选择由两名独立评审员进行。
两名评审员使用标准化清单独立评估试验质量并提取数据。只要有可能，结果将基于意向性分析。对于二分法结局，计算固定比值比及95%置信区间；对于连续性结局指标，计算加权或（若使用不同量表）标准化均数差及95%置信区间。在受试者、治疗方法、结局及随访时间点等方面具有临床同质性时进行数据合并。
纳入的四项试验共涉及514例患者，方法学质量一般。三项安慰剂对照试验（假超声）中，在随访七天时，对于任何结局指标，均未显示真超声治疗与假超声治疗之间存在统计学显著差异。超声与假超声比较时，总体改善的合并比值比为1.19（Peto固定效应模型，95%置信区间0.73至1.93）。干预组之间的差异通常较小，大多数二分法结局在0%至6%之间。然而，一项试验报告称，在无痛状态（20%）和肿胀（25%）方面，超声治疗的差异相对较大。
超声治疗急性踝关节扭伤的现有证据的范围和质量有限。三项安慰剂对照试验的结果不支持使用超声治疗踝关节扭伤。大多数报告的治疗效果幅度较小，临床重要性可能有限。目前仅有少数试验，关于超声治疗的最佳和适当剂量方案，以及该方案是否会提高超声治疗踝关节扭伤的报告有效性，尚无定论。
