Zwipp H, Tscherne H, Hoffmann R, Wippermann B
Orthopade. 1986 Nov;15(6):446-53.
In a prospective, random study carried out at the Casualty Clinic of the University Hospital of Hannover from 15 April 1986 to 31 July 1986, 200 patients were randomly selected from four treatment groups, according to treatment: operative-immobilized (group A, n = 52), operative-functional (group B, n = 50), conservative-immobilized (group C, n = 48) and conservative-functional (group D, n = 50). Follow-up examinations were made in 92.5% of patients after 3 months and 64% after 12 months. At the 3-month and 1-year follow-ups, no statistically significant differences were found in the total evaluation (100-point checklist) Moderately significant instability (6 degrees -10 degrees talar tilt and 6-10 mm anterior talar dislocation) in the conservative groups C and D was observed only in the clinical-radiological instability test. This statistically significant difference is, however, only evident in stress tenographically confirmed dual-ligament lesions. No functional physiological differences can be found after 12 months; on average, the period of incapacitation is 3 weeks shorter than with primary functional treatment, but so far there are no long-term results. Until late results are available, we conclude that conservative treatment, even for professional athletes, can be recommended as the procedure most free of risk and most economical; if at all, operative therapy should only be carried out when the instability is very serious.
1986年4月15日至1986年7月31日在汉诺威大学医院急诊诊所进行了一项前瞻性随机研究，从四个治疗组中随机选取200例患者，依据治疗方式分组如下：手术固定组（A组，n = 52）、手术功能组（B组，n = 50）、保守固定组（C组，n = 48）和保守功能组（D组，n = 50）。92.5%的患者在3个月后接受了随访检查，64%的患者在12个月后接受了随访检查。在3个月和1年的随访中发现，总体评估（100分检查表）无统计学显著差异。仅在临床 - 放射学不稳定测试中观察到保守治疗的C组和D组存在中度显著不稳定（距骨倾斜6度 - 10度，距骨前方脱位6 - 10毫米）。然而，这种统计学显著差异仅在应力造影证实的双韧带损伤中明显。12个月后未发现功能生理差异；平均而言，失能期比初次功能治疗短3周，但目前尚无长期结果。在获得晚期结果之前，我们得出结论，即使对于职业运动员，保守治疗也可作为风险最小且最经济的治疗方法推荐；如果需要进行手术治疗，也仅应在不稳定非常严重时进行。
