Department of Trauma and Orthopaedic Surgery, Frimley Park Hospital, Surrey, UK.
Clin Orthop Relat Res. 2010 Jan;468(1):243-51. doi: 10.1007/s11999-009-0988-2. Epub 2009 Jul 18.
Stability is a key issue in treating supination-external rotation ankle fractures, but we do not know how it affects functional outcome and subsequent development of radiographic osteoarthritis. With a systematic literature review, we identified 11 clinical studies (Level IV evidence) published in peer-reviewed journals reporting on at least 10 ankles. Followup was at least 1 year. Two authors independently scored the quality of the studies using the modified Coleman Methodology Score; the mean score was 58 of 100, with substantial agreement between the two examiners. Four studies used a general health assessment questionnaire. Several literature limitations (debatable fracture stability criteria, few cohort studies with heterogeneous methodology, small patient numbers and limited followup in some studies) do not allow definitive conclusions. Of 213 stable fractures treated nonoperatively, 2.8% of ankles had radiographic osteoarthritis develop (18 years' mean followup) and 84% were free of symptoms. The incidence of radiographic osteoarthritis in 420 unstable fractures treated operatively was 20.9% at 5.5 years versus 65.5% at 6.8 years in 137 ankles treated nonoperatively. The complication rate in 355 operatively treated fractures was 10.4%. A medial malleolus fracture, female gender, older age, higher American Society of Anesthesiologists grade, smoking, and lower educational level negatively influenced general health outcome, physical function, and pain.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
治疗外旋外展型踝关节骨折的关键问题是稳定性，但我们尚不清楚其如何影响功能结果和随后的放射学骨关节炎发展。通过系统文献回顾，我们确定了 11 项已发表在同行评议期刊上的临床研究（IV 级证据），这些研究至少报告了 10 例踝关节。随访时间至少 1 年。两位作者使用改良 Coleman 方法评分独立对研究质量进行评分；平均得分为 100 分中的 58 分，两位检查者之间存在实质性一致性。四项研究使用了一般健康评估问卷。存在一些文献局限性（骨折稳定性标准存在争议、少数队列研究方法学存在差异、患者数量较少且部分研究随访时间有限），无法得出明确的结论。213 例接受非手术治疗的稳定性骨折中，2.8%的踝关节出现放射学骨关节炎（18 年平均随访），84%无症状。420 例接受手术治疗的不稳定性骨折中，5.5 年时手术组的放射学骨关节炎发生率为 20.9%，而 137 例非手术治疗组的发生率为 65.5%。355 例手术治疗骨折的并发症发生率为 10.4%。内踝骨折、女性、年龄较大、美国麻醉医师协会分级较高、吸烟和教育程度较低均对一般健康状况、身体功能和疼痛产生负面影响。
IV 级，治疗性研究。欲了解完整的证据等级描述，请参见作者指南。
