摘要
目的比较切开复位内固定术与保守治疗移位跟骨关节内骨折的临床疗效。方法收集所有切开复位内固定术与保守治疗比较治疗移位跟骨关节内骨折的随机对照试验(RCT),按Cochrnae协作网标准逐个进行质量评价和Meta分析。结果共纳入4篇RCT,包括530例患者。4个研究显示,在返回原来工作岗位、距下关节活动范围、Bohler's角的恢复上,切开复位内固定术优于保守治疗。在足跟残留疼痛方面,两种方法的差异无统计学意义。而其治疗效果评分因不同研究采用的结局评价标准不同,无法进行合并分析。结论切开复位内固定术与保守治疗均是有移位的跟骨关节内骨折的有效治疗方法。切开复位内固定术在返回原来工作岗位、距下关节活动范围、Bohler's角的恢复上优于保守治疗。两种方法在足跟残留疼痛方面无差别。因本研究的样本量太小,纳入的研究数量少,方法学质量不高,缺乏足够的证据,尚需更多设计严格的研究以增加证据的强度。
Objective To compare the effects of operative versus nonoperative treatment for displaced intraarticular calcaneal fractures. Methods All randomized controlled trials （RCTs） of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently. Results Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler＇s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a metaanalysis could not be performed. Conclusions Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.
出处
《中国循证医学杂志》
CSCD
2007年第4期276-282,共7页
Chinese Journal of Evidence-based Medicine
关键词
移位
跟骨关节内骨折
切开复位内固定术
保守治疗
随机对照试验
系统评价
Displaced
Intra-articular calcaneal fractures
Operative treatment
Nonoperative treatment
Randomized controlled trials
Systematic review
