Michelson James D, Magid Donna, McHale Kathleen
Department of Orthopedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
J Orthop Trauma. 2007 May;21(5):307-15. doi: 10.1097/BOT.0b013e318059aea3.
Neither of the ankle fracture classification systems (Lauge-Hansen or Weber) in widespread use today is prognostic. To test the hypothesis that ankle fracture prognosis is dependent on initial biomechanical stability, an alternative classification system created using stability-based treatment criteria was developed on the basis of a structured analysis of the ankle fracture literature.
All English-language papers reporting on ankle fractures (searched using the terms "ankle + fracture") published between 1966 and 2005 with available online abstracts via PubMed were screened.
Abstracts were manually screened for inclusion using the following criteria: (1) there were at least 2 groups of patients categorized on the basis of either fracture configuration or treatment and (2) data was reported in sufficient detail to permit interstudy comparisons.
Each included paper was abstracted into a computerized database for consistent data capture. Data elements included the following: fracture classification, stability definitions, surgical indications, patient follow-up parameters, and outcome measures. Ankle fractures were also stratified into stable and unstable groups using predefined stability criteria, and the outcome measures were re-analyzed.
Wilcoxon matched-pairs signed-rank test was used for statistical comparisons, assigning statistical significance to 2-tailed tests with P < 0.05.
The results support the hypothesis that a stability-based ankle fracture classification system can be prognostic. For unstable ankle fractures, the radiographic outcomes were better after surgery, when the decision for surgery was made on the basis of stability (P = 0.0173). Overall, non-operative treatment results were also better with stability-based treatment (P = 0.0299).
目前广泛使用的两种踝关节骨折分类系统（Lauge-Hansen 或 Weber 分类系统）均不具有预后判断价值。为验证踝关节骨折预后取决于初始生物力学稳定性这一假说，在对踝关节骨折文献进行结构化分析的基础上，开发了一种基于稳定性治疗标准的替代性分类系统。
筛选了 1966 年至 2005 年间发表的、通过 PubMed 可获取在线摘要的所有报道踝关节骨折的英文论文（使用“ankle + fracture”进行检索）。
使用以下标准对摘要进行人工筛选以确定纳入：（1）至少有两组患者根据骨折形态或治疗方法进行分类，（2）报告的数据足够详细以允许进行研究间比较。
将每篇纳入的论文摘要录入计算机化数据库以实现一致的数据采集。数据元素包括：骨折分类、稳定性定义、手术指征、患者随访参数和结局指标。还使用预定义的稳定性标准将踝关节骨折分为稳定组和不稳定组，并对结局指标进行重新分析。
采用 Wilcoxon 配对符号秩检验进行统计比较，将双侧检验的统计学显著性设定为 P < 0.05。
结果支持基于稳定性的踝关节骨折分类系统具有预后判断价值这一假说。对于不稳定型踝关节骨折，当基于稳定性决定是否手术时，术后影像学结果更好（P = 0.0173）。总体而言，基于稳定性的治疗方法的非手术治疗结果也更好（P = 0.0299）。
