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成人踝关节骨折使用石膏固定的疗效并不优于可移动支架
作者:小柯机器人 发布时间:2021/7/10 18:13:24

英国华威大学Rebecca Kearney团队比较了在成人踝关节骨折中使用石膏固定与可移动支架的效果。2021年7月6日,《英国医学杂志》发表了这一成果。

为了评估成人踝关节骨折石膏固定与可移动支架治疗的功能、生活质量、资源利用和并发症,研究组在英国国家卫生服务中心的20个创伤科进行了一项多中心随机对照试验,共招募了669名年龄在18岁及以上的急性踝关节骨折且适合石膏固定的成年人。

将其随机分组,其中334名应用膝下石膏固定,并在移除石膏时开始踝关节范围的运动训练;335名接受可移动支架,并立即开始踝关节范围的运动训练。主要观察指标为16周时Olerud Molander踝关节评分,按治疗意向分析。次要结果为6、10和16周时的曼彻斯特-牛津足问卷、残疾评定指数、生活质量和并发症。

参与者的平均年龄为46岁,女性381人(57%)。502名(75%)参与者完成了研究。16周时,石膏组和可移动支架组的Olerud Molander踝关节评分无统计学差异。在次要未校正分析、插补分析或按方案分析中,两组其他时间点的Olerud Molander踝关节评分亦未发现临床显著性差异。

研究结果表明,对于成人踝关节骨折患者,传统石膏固定并不优于功能性支架。两组16周时Olerud-Molander踝关节评分无统计学差异。

附:英文原文

Title: Use of cast immobilisation versus removable brace in adults with an ankle fracture: multicentre randomised controlled trial

Author: Rebecca Kearney, Rebecca McKeown, Helen Parsons, Aminul Haque, Nick Parsons, Henry Nwankwo, James Mason, Martin Underwood, Anthony C Redmond, Jaclyn Brown, Siobhan Kefford, Matthew Costa

Issue&Volume: 2021/07/06

Abstract:

Objectives To assess function, quality of life, resource use, and complications in adults treated with plaster cast immobilisation versus a removable brace for ankle fracture.

Design Multicentre randomised controlled trial.

Setting 20 trauma units in the UK National Health Service.

Participants 669 adults aged 18 years and older with an acute ankle fracture suitable for cast immobilisation: 334 were randomised to a plaster cast and 335 to a removable brace.

Interventions A below the knee cast was applied and ankle range of movement exercises started on cast removal. The removable brace was fitted, and ankle range of movement exercises were started immediately.

Main outcome measures Primary outcome was the Olerud Molander ankle score at 16 weeks, analysed by intention to treat. Secondary outcomes were Manchester-Oxford foot questionnaire, disability rating index, quality of life, and complications at 6, 10, and 16 weeks.

Results The mean age of participants was 46 years (SD 17 years) and 381 (57%) were women. 502 (75%) participants completed the study. No statistically significant difference was found in the Olerud Molander ankle score between the cast and removable brace groups at 16 weeks (favours brace: 1.8, 95% confidence interval 2.0 to 5.6). No clinically significant differences were found in the Olerud Molander ankle scores at other time points, in the secondary unadjusted, imputed, or per protocol analyses.

Conclusions Traditional plaster casting was not found to be superior to functional bracing in adults with an ankle fracture. No statistically difference was found in the Olerud Molander ankle score between the trial arms at 16 weeks.

DOI: 10.1136/bmj.n1506

Source: https://www.bmj.com/content/374/bmj.n1506

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj