van Rijn Rogier M, van Os Anton G, Bernsen Roos M D, Luijsterburg Pim A, Koes Bart W, Bierma-Zeinstra Sita M A
Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
Am J Med. 2008 Apr;121(4):324-331.e6. doi: 10.1016/j.amjmed.2007.11.018.
Ankle sprains are one of the most common musculoskeletal injuries. In order to evaluate the effectiveness of therapeutic interventions and to guide management decisions, it is important to have clear insight of the course of recovery after an acute lateral ankle injury and to evaluate potential factors for nonrecovery and re-sprains.
A database search was conducted in MEDLINE, CINAHL, PEDro, EMBASE, and the Cochrane Controlled trial register. Included were observational studies and controlled trials with adult subjects who suffered from an acute lateral ankle sprain that was conventionally treated. One of the following outcomes had to be described: pain, re-sprains, instability, or recovery. Two reviewers independently assessed the methodological quality of each included study. One reviewer extracted relevant data.
In total, 31 studies were included, from which 24 studies were of high quality. There was a rapid decrease in pain reporting within the first 2 weeks. Five percent to 33% of patients still experienced pain after 1 year, while 36% to 85% reported full recovery within a period of 3 years. The risk of re-sprains ranged from 3% to 34% of the patients, and re-sprain was registered in periods ranging from 2 weeks to 96 months postinjury. There was a wide variation in subjective instability, ranging from 0% to 33% in the high-quality studies and from 7% to 53% in the low-quality studies. One study described prognostic factors and indicated that training more than 3 times a week is a prognostic factor for residual symptoms.
After 1 year of follow-up, a high percentage of patients still experienced pain and subjective instability, while within a period of 3 years, as much as 34% of the patients reported at least 1 re-sprain. From 36% up to 85% of the patients reported full recovery within a period of 3 years.
踝关节扭伤是最常见的肌肉骨骼损伤之一。为了评估治疗干预措施的有效性并指导管理决策，清楚了解急性外侧踝关节损伤后的恢复过程以及评估未恢复和再次扭伤的潜在因素非常重要。
在MEDLINE、CINAHL、PEDro、EMBASE和Cochrane对照试验注册库中进行了数据库检索。纳入的是对成年急性外侧踝关节扭伤患者进行常规治疗的观察性研究和对照试验。必须描述以下结果之一：疼痛、再次扭伤、不稳定或恢复情况。两名审查员独立评估每项纳入研究的方法学质量。一名审查员提取相关数据。
总共纳入了31项研究，其中24项研究质量较高。在最初2周内疼痛报告迅速减少。1年后仍有5%至33%的患者经历疼痛，而36%至85%的患者报告在3年内完全恢复。再次扭伤的风险在患者中的比例为3%至34%，再次扭伤记录的时间范围为受伤后2周至96个月。主观不稳定存在很大差异，高质量研究中为0%至33%，低质量研究中为7%至53%。一项研究描述了预后因素，并指出每周训练超过3次是残留症状的预后因素。
随访1年后，仍有很大比例的患者经历疼痛和主观不稳定，而在3年内，多达34%的患者报告至少有1次再次扭伤。36%至85%的患者报告在3年内完全恢复。
