van Ochten John M, van Middelkoop Marienke, Meuffels Duncan, Bierma-Zeinstra Sita M A
Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Orthop Sports Phys Ther. 2014 Nov;44(11):862-71, C1-23. doi: 10.2519/jospt.2014.5221. Epub 2014 Oct 9.
Systematic review. Objective To determine the effectiveness of treatments for patients with chronic complaints after ankle sprain.
Though most people recover completely after a lateral inversion ankle injury, a considerable percentage have persistent complaints. Currently, it is still unclear which treatment options are best for these patients.
Major databases, including PubMed, Embase, CINAHL, and PEDro, were searched for randomized controlled trials and controlled clinical trials conducted from 1966 to October 2012. Due to clinical heterogeneity, the data were analyzed using a best-evidence synthesis.
A total of 20 randomized controlled trials and 1 controlled clinical trial were included in the analysis. The included studies compared different treatments (training programs, physiotherapy, chiropractic/manual therapy, surgery, postoperative training, and functional treatment). For pain and function outcomes, limited to moderate evidence was found for effectiveness of a training program compared to conservative treatment. Two studies found a decrease of recurrences after a proprioceptive training program. Four studies showed good results for different surgical methods but did not include a nonsurgical control group for comparison. Limited evidence was found for the effectiveness of an early mobilization program after surgery.
In chronic ankle complaints after an ankle sprain, a training program gives better results for pain and function, and a decrease of recurrent ankle sprains, than a wait-and-see policy. There was insufficient evidence to determine the most effective surgical treatment, but limited evidence suggests that postoperative, early mobilization was more effective than a plaster cast.
Therapy, level 1a-.
系统评价。目的：确定踝关节扭伤后慢性症状患者的治疗效果。
尽管大多数人在外侧翻转踝关节损伤后能完全康复，但仍有相当比例的人存在持续症状。目前，对于这些患者哪种治疗方案最佳仍不明确。
检索主要数据库，包括PubMed、Embase、CINAHL和PEDro，查找1966年至2012年10月期间进行的随机对照试验和对照临床试验。由于临床异质性，采用最佳证据综合法分析数据。
分析共纳入20项随机对照试验和1项对照临床试验。纳入研究比较了不同治疗方法（训练计划、物理治疗、整脊/手法治疗、手术、术后训练和功能治疗）。对于疼痛和功能结局，与保守治疗相比，训练计划有效性的证据有限至中等。两项研究发现本体感觉训练计划后复发率降低。四项研究显示不同手术方法效果良好，但未设非手术对照组进行比较。术后早期活动计划有效性的证据有限。
在踝关节扭伤后的慢性踝关节症状中，与观望策略相比，训练计划在疼痛和功能方面效果更好，且能降低踝关节扭伤复发率。尚无足够证据确定最有效的手术治疗方法，但有限证据表明术后早期活动比石膏固定更有效。
治疗，1a-级。
