摘要
目的对手术治疗和非手术治疗急性踝关节外侧副韧带损伤的疗效与术后并发症进行Meta分析。方法计算机检索MEDLINE（从1966年至2011年10月）、EMbase（从1988年1月至2011年10月）、中国生物医学文献数据库（从1978年1月至2011年10月）和中国知网数据库（从1980年1月至2011年10月），收集比较手术治疗和非手术治疗急性踝关节外侧副韧带损伤的随机对照试验（RCT）、临床对照试验、半随机对照试验、队列研究等，评价纳入研究的方法学质量，并提取有效数据进行Meta分析，以比较手术治疗与非手术治疗后踝关节活动水平恢复、踝关节功能稳定性、踝关节损伤复发、踝关节残留疼痛及治疗后并发症的差异。结果纳入13个RCTs，其中手术治疗713例，非手术治疗817例。Meta分析显示，手术治疗踝关节功能稳定性显著优于非手术治疗[OR=0．72。95％CI（0．52，0．99），P〈0．05]，手术治疗踝关节强直的发生率[OR=3．41，95％CI为（1．56，7．44）】显著高于非手术治疗。手术治疗与非手术治疗关节活动水平恢复【OR=1．14，95％CI（0．58，2．21）】、踝关节损伤复发[OR=0．68，95％CI（0．35，1．31）】、残留疼痛[OR=0．81，95％CI（0．56，1．16）】、关节活动障碍[OR=2．38，95％CI（0．91，6．25）】发生率差异均无统计学意义（P〉0．05）。手术治疗损伤部位瘢痕[OR=7．46，95％CI（1．32，42．08），P〈0．05]和感觉神经丧失[OR=12．16，95％CI（2．24，66．02），P〈0．05]发生率均高于非手术治疗，手术治疗并发症总发生率显著高于非手术治疗[OR=6．20，95％CI（2．67，14．41），P〈0．05]。结论手术治疗急性踝关节外侧副韧带损伤与非手术治疗相比，能显著提高踝关节稳定性，但踝关节活动水平的恢复、损伤复发和关节残留疼痛无显著差异，且会增加并发症发生的风险。
Objective To systematically compare the operative and non-operative treatments of acute injury to the lateral ankle ligaments in terms of efficacy and complications. Methods The databases of MEDLINE （From January 1966 to October 2011 ）, EMBASE （From January 1988 to October 2011 ）, CB- Mdisc （From January 1978 to October 2011） and CNKI （From January 1980 to October 2011 ） were researched for eligible randomized-controlled trials （RCTs）, controlled clinical trials, quasi randomized controlled trials and cohort study which compared operative and non-operative treatments for acute injury to the lateral ankle ligaments. The methodological quality of the eligible studies collected was evaluated. The data of the studies included were extracted for a Meta analysis to compare the motional recovery, functional stability, re-injury, residual pain and post-treatment complications of the ankle between operative and non-operative treatments. RevMan 5.0 software was used for statistical analysis. Results In all the eligible 13 studies included, 713 patients were treated operatively and 817 patients non-operatively. The functional stability of the ankle was significantly better in the operative treatment group than in the non-operative treatment group [OR=0.72, 95% CI, （0.52, 0.99）, P 〈0.05] . The incidence of ankle arthrocleisis in the operative treatment group was significantly higher than in the non-operative treatment group [ OR = 3.41, 95% CI （1.56, 7.44）, P =0. 002] . There were no statistical differences in the motional recovery [ OR = 1.14, 95% CI （0.58, 2.21）, P〉 0.05], incidence ofre-injury [OR=0.68, 95% CI （0.35, 1.31）, P〉 0. 05], residual pain [ OR = O. 81, 95% CI （0. 56, 1.16）, P 〉 0. 05], or ankle dyskinesia [ OR = 2. 38,95% CI （0. 91, 6. 25）, P 〉 0. 05] between the 2 groups. The incidences, scar tenderness [ OR =7.46, 95% CI（1. 32,42. 08）, P 〈 0. 05] and sensory nerve loss [ OR = 12. 16, 95% CI（2. 24, 66. 02）, P 〈 0. 05] were significantly higher in the operative treatment group than in the non-operative treatment group. The total rate of complications was significantly higher in the operative treatment group than in the non-operative treatment group [ OR = 6. 20, 95% Cl （2. 67, 14.41）, P 〈 0. 05] . Conclusions Compared with non-operative treat- ments, operative treatments for acute injury to the lateral ankle ligaments can significantly improve the functional stability of the ankle, but make no significant differences in the motional restoration, re-injury or the residual pain of the ankle. In addition, operative treatments may increase the risk of complications.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第6期500-506,共7页
Chinese Journal of Orthopaedic Trauma
基金
基金项目：广州市科技攻关项目（200821-E441）
关键词
踝损伤
外侧韧带
踝
META分析
手术治疗
非手术治疗
Ankle injuries
Lateral ligament, ankle
Meta-analysis
Surgical procedures, operative
Non-operative treatment
