手术治疗的踝关节骨折无需固定即可立即负重是安全的——系统评价。
Immediate weight bearing without immobilization for operatively treated ankle fractures is safe - A systematic review.
机构信息
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, Munich 80336, Germany.
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Foot Ankle Surg. 2023 Jun;29(4):306-316. doi: 10.1016/j.fas.2023.04.006. Epub 2023 Apr 15.
BACKGROUND
This systematic literature review compared weight bearing (WB) vs. partial- / non-weight bearing (NWB) and mobilization (MB) vs. immobilization (IMB) for surgically treated ankle fractures.
METHODS
Five databases were searched. Eligible were (quasi-)randomized controlled trials comparing at least two different postoperative treatment protocols. The risk of bias was assessed using the RoB-2 toolkit. The primary outcome was complication rate, secondary outcome Olerud and Molander Ankle Score (OMAS), range of motion (ROM), and return to work (RTW).
RESULTS
Out of 10,345 studies, 24 papers were eligible. Thirteen studies (n = 853) compared WB/NWB, 13 studies (n = 706) MB/IMB with a moderate study quality. WB did not increase the risk for complications but resulted in superior short-term outcomes for OMAS, ROM, RTW. 12 studies found no inferior results for MB compared to IMB.
CONCLUSION
Early and immediate WB and MB do not increase the complication rates but result in superior short term outcome scores.
LEVEL OF EVIDENCE
Level I Systematic Review.
背景
本系统文献回顾比较了手术治疗踝关节骨折后负重（WB）与部分/非负重（NWB）和活动（MB）与固定（IMB）的效果。
方法
检索了五个数据库。纳入了比较至少两种不同术后治疗方案的（准）随机对照试验。使用 RoB-2 工具包评估偏倚风险。主要结局指标是并发症发生率，次要结局指标为 Olerud 和 Molander 踝关节评分（OMAS）、活动范围（ROM）和重返工作（RTW）。
结果
在 10345 项研究中，有 24 篇论文符合纳入标准。13 项研究（n=853）比较了 WB/NWB，13 项研究（n=706）比较了 MB/IMB，研究质量为中等。WB 并未增加并发症风险，但在 OMAS、ROM、RTW 方面的短期结果更好。12 项研究发现 MB 与 IMB 相比，没有较差的结果。
结论
早期和即刻的 WB 和 MB 不会增加并发症发生率，但会带来更好的短期结局评分。
证据等级
一级系统评价。
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