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Different functional treatment strategies for acute lateral ankle ligament injuries in adults

  • Review
  • Intervention

Authors


Abstract

Background

Acute lateral ankle ligament ruptures are common problems in present health care. Early mobilisation and functional treatment are advocated as a preferable treatment strategy. However, functional treatment comprises a broad spectrum of treatment strategies and as of yet no optimal strategy has been identified.

Objectives

The objective of this review is to assess different functional treatment strategies for acute lateral ankle ligament ruptures in adults.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (December 2001), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to May 2000), EMBASE (1980 to May 2000), CURRENT CONTENTS (1993 to 1999), BIOSIS (to 1999), reference lists of articles, and contacted organisations and researchers in the field.

Selection criteria

Randomised clinical trials describing skeletally mature individuals with an acute lateral ankle ligament rupture and comparing different functional treatment strategies were evaluated for inclusion.

Data collection and analysis

Two reviewers independently assessed the quality of included trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (WMD) for continuous outcome measures with 95 per cent confidence intervals (95%CI). Heterogeneity between trials was tested using a standard chi-squared test.

Main results

Nine trials involving 892 participants were included. Lace-up ankle support had significantly better results for persistent swelling at short-term follow up when compared with semi-rigid ankle support (RR 4.19, 95% CI 1.26 to 13.98); elastic bandage (RR 5.48; 95% CI 1.69 to 17.76); and to tape (RR 4.07, 95% CI 1.21 to 13.68). Use of a semi-rigid ankle support resulted in a significantly shorter time to return to work when compared with an elastic bandage (WMD (days) 4.24; 95% CI 2.42 to 6.06); one trial found the use of a semi-rigid ankle support saw a significantly quicker return to sport compared with elastic bandage (RR 9.60; 95% CI 6.34 to 12.86) and another trial found fewer patients reported instability at short-term follow-up when treated with a semi-rigid support than with an elastic bandage (RR 8.00; 95% CI 1.03 to 62.07). Tape treatment resulted in significantly more complications, the majority being skin irritations, when compared with treatment with an elastic bandage (RR 0.11; 95% CI 0.01 to 0.86). No other results showed statistically significant differences.

Authors' conclusions

The use of an elastic bandage has fewer complications than taping but appears to be associated with a slower return to work and sport, and more reported instability than a semi-rigid ankle support. Lace-up ankle support appears to be effective in reducing swelling in the short-term compared with semi-rigid ankle support, elastic bandage and tape. However, definitive conclusions are hampered by the variety of treatments used, and the inconsistency of reported follow-up times. The most effective treatment, both clinically and in costs, is unclear from currently available randomised trials.

摘要

背景

治療成年人急性側邊踝韌帶受傷之不同的功能性治療策略

急性側邊踝韌帶破裂在現今的醫療照護上是個相當常見的問題。早期活動及功能性治療是目前較偏向於使用的治療策略。然而,功能性治療是個非常廣泛的治療策略,且目前尚未發掘出其它較理想的療法。

目標

本篇文獻回顧的目標是評估用來治療成年人急性側邊踝韌帶受傷之不同的功能性治療策略。

搜尋策略

我們搜尋了 the Cochrane Musculoskeletal Injuries Group specialised register (2001年12月)、the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001年)、MEDLINE (1966年 −2000年5月)、EMBASE (1980年 −2000年5月)年、 CURRENT CONTENTS (1993年 −1999年)、BIOSIS (−1999年) 、 文章的參考文獻清單,以及連絡該領域的機構以及研究人員。

選擇標準

隨機臨床試驗主要納入骨骼成熟且患有急性側邊踝韌帶受傷的成年人,並在結論中提出評估不同的功能性治療策略的結果。

資料收集與分析

兩位文獻回顧者獨立地評估納入之試驗的試驗品質並從治療結果中擷取相關數據。 只要是適當的,比較性研究的結果都會被收集彙整。 個案及所收集到的統計數字會以相對危險比 (relative risks; RR)來代表兩者的結果,而重量平均差 (weighted mean differences; WMD)則是代表伴隨95%的信賴區間 (confidence intervals; 95%CI)來做連續結果的測量。 試驗之間的異質性會以卡方測驗 (chisquared test)來做測試。

主要結論

我們納入了包括892位參與者的九個試驗。 使用有鞋帶的腳踝支持法對於短期追蹤中持續性的腫脹有明顯的療效,尤其與半硬式腳踝支持法來做比較時 (RR 4.19, 95% CI 1.26 to 13.98);彈性繃帶(RR 5.48; 95% CI 1.69 to 17.76);和貼紮 (RR 4.07, 95% CI 1.21 to 13.68)。 比起彈性繃帶 (WMD (days) 4.24; 95% CI 2.42 to 6.06)來說,使用半硬式腳踝支持法會使病患更早回到工作岡位。 一個試驗發現使用半硬式腳踝支持法比起使用彈性繃帶對病人來說會縮短回到工作岡位的時間 (RR 9.60; 95% CI 6.34 to 12.86),而另一個研究發現有少數病患在以半硬式腳踝支持法取代彈性繃帶時,短期追蹤時會比較穩定 (RR 8.00; 95% CI 1.03 to 62.07)。 比起使用彈性繃帶時 (RR 0.11; 95% CI 0.01 to 0.86),貼紮治療會導致明顯的併發症,大部分是皮膚過敏。 結果中沒有其他顯著的不同。

作者結論

使用彈性繃帶取代貼紮後會引發較少併發症,但是會使回到工作岡位或可以運動的時間延長,更有研究指出比起半硬式腳踝支持法更具穩定性。 比起半硬式腳踝支持法、彈性繃帶、或膠布而言,繫鞋帶的腳踝支持法對於降低短期追蹤的腫脹有效。 然而,最後的結論會被不同的療法、以及追蹤時間的不一致所阻礙。 最有效的療法(同時對臨床及成本來說)目前仍無法從隨機試驗中獲知。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於腳踝扭傷來說,使用支持性療法(半硬式腳踝支持法或繫鞋帶支持法)的協助來回復功能是個好選擇。 當人扭傷腳踝時,常常會傷到將骨頭連接到腳踝側處的韌帶(側踝關節韌帶)。 有時僅會是輕微的過度伸展,有時卻會是完全的斷裂。 主要的三個治療方法為石膏或夾板,手術或使用繃帶或其他外力支持物(功能性治療)來保持踝關節使用。 本篇文獻回顧認為在功能性治療的研究上發現使用彈性繃帶比貼紮更容易引起些許併發症,但就復原速度而言,加上半硬式腳踝支持法或繫鞋帶支持法的協助可能會比較快。

Plain language summary

Different functional treatment strategies for acute lateral ankle ligament injuries in adults

When people sprain their ankles, they often injure the ligaments connecting the bones on the side of the ankle (lateral ankle ligaments). The damage might be a mild over-stretching or a complete rupture (break). The three main treatments are plaster casts or splints, surgery or keeping the ankle in use with external support from strapping or other supports (functional treatment). This review of trials looking at functional treatment found that elastic bandages lead to few complications than taping, but recovery might be faster with a semi-rigid ankle or lace-up support. More research is needed.

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