Kerkhoffs G M, Rowe B H, Assendelft W J, Kelly K D, Struijs P A, van Dijk C N
University of Amsterdam, Academic Medical Center, Department of Orthopaedic Surgery, The Netherlands.
Arch Orthop Trauma Surg. 2001 Sep;121(8):462-71. doi: 10.1007/s004020100283.
The variation of practice with respect to the treatment of the acutely sprained ankle suggests a lack of evidence-based management strategies for this problem. The objective of this review was to assess the effectiveness of the various methods of immobilisation for acute ankle sprain. An electronic database search was conducted using MEDLINE, EMBASE, BIOSIS, CINAHL, Cochrane Controlled Trial Register and Current Contents. Randomised and quasi-randomised clinical trials describing skeletally mature individuals with an acute ankle sprain and comparing immobilisation for the treatment of injuries to the lateral ligament complex of the ankle were evaluated for inclusion. Two reviewers independently assessed the validity of included trials and extracted relevant data on the treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcomes and weighted mean differences (WMD) for continuous outcome measures with 95% confidence intervals (95% CI). Heterogeneity between trials was tested using a standard chi-square test. A total of 22 studies met the inclusion criteria. Statistically significant differences were found for six outcome measures, all in favour of functional treatment compared with immobilisation: return to sports (RR: 1.85; 95% CI: 1.2 to 2.8), (WMD: 4.57 days; 95% CI: 1.5 to 7.6), return to work (WMD: 7.12 days; 95% CI: 5.6 to 8.7), persistent swelling (RR: 1.44; 95% CI: 1.1 to 2.0), objective instability by stress X-ray (WMD: 2.48; 95% CI: 1.3 to 3.6), range of motion (RR: 1.64; 95% CI: 1.1 to 2.6) and patient satisfaction (RR: 6.50; 95% CI: 1.8 to 24) . None of the other results were significantly in favour of immobilisation. Sensitivity analysis showed that a non-concealed treatment allocation did not influence the statistical significance of the overall results. Based on our results, functional treatment currently seems a more appropriate treatment and should be encouraged. Concerning effectiveness, immobilisation, if necessary, should be restricted to certain patients and for short time periods.
在急性踝关节扭伤治疗方面的实践差异表明，针对这一问题缺乏基于证据的管理策略。本综述的目的是评估急性踝关节扭伤各种固定方法的有效性。通过使用MEDLINE、EMBASE、BIOSIS、CINAHL、Cochrane对照试验注册库和《现刊目次》进行电子数据库检索。纳入评估的是描述骨骼成熟的急性踝关节扭伤个体，并比较踝关节外侧韧带复合体损伤治疗中固定方法的随机和半随机临床试验。两名评审员独立评估纳入试验的有效性，并提取关于治疗结果的相关数据。在适当情况下，汇总可比研究的结果。个体和汇总统计数据以二分结果的相对风险（RR）和连续结果测量的加权平均差（WMD）以及95%置信区间（95%CI）报告。使用标准卡方检验检测试验之间的异质性。共有22项研究符合纳入标准。在六项结果测量中发现了统计学上的显著差异，所有这些差异均表明与固定相比，功能治疗更具优势：恢复运动（RR：1.85；95%CI：1.2至2.8），（WMD：4.57天；95%CI：1.5至7.6），恢复工作（WMD：7.12天；95%CI：5.6至8.7），持续性肿胀（RR：1.44；95%CI：1.1至2.0），应力X线检查显示的客观不稳定（WMD：2.48；95%CI：1.3至3.6），活动范围（RR：1.64；95%CI：1.1至2.6）以及患者满意度（RR：6.50；95%CI：1.8至24）。其他结果均没有显著表明固定更具优势。敏感性分析表明，非隐藏性治疗分配并不影响总体结果的统计学显著性。基于我们的结果，目前功能治疗似乎是更合适的治疗方法，应予以鼓励。关于有效性，如果有必要，固定应仅限于某些患者且时间较短。
