切開復位內固定術與保守治療比較治療移位的跟骨關節內骨折的系統評價_《中國循證醫學雜志》

作者：

 王翀 , 田禾 , 屈建華 , 田征

新疆醫科大學第一附屬醫院骨科（烏魯木齊 830054）;

關鍵詞：

移位跟骨關節內骨折切開復位內固定術保守治療隨機對照試驗系統評價

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目的　比較切開復位內固定術與保守治療移位跟骨關節內骨折的臨床療效。
方法　收集所有切開復位內固定術與保守治療比較治療移位跟骨關節內骨折的隨機對照試驗（RCT），按Cochrnae協作網標準逐個進行質量評價和Meta分析。
結果　共納入4篇RCT，包括530例患者。4個研究顯示，在返回原來工作崗位、距下關節活動范圍、Bohler’s角的恢復上，切開復位內固定術優于保守治療。在足跟殘留疼痛方面，兩種方法的差異無統計學意義。而其治療效果評分因不同研究采用的結局評價標準不同，無法進行合并分析。
結論　切開復位內固定術與保守治療均是有移位的跟骨關節內骨折的有效治療方法。切開復位內固定術在返回原來工作崗位、距下關節活動范圍、Bohler’s角的恢復上優于保守治療。兩種方法在足跟殘留疼痛方面無差別。因本研究的樣本量太小，納入的研究數量少，方法學質量不高，缺乏足夠的證據，尚需更多設計嚴格的研究以增加證據的強度。

引用本文： 王翀,田禾,屈建華,田征. 切開復位內固定術與保守治療比較治療移位的跟骨關節內骨折的系統評價. 中國循證醫學雜志, 2007, 07(4): 276-282. doi: 復制

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2.	Heppnstall RB. Fracture Treatment and Healing. Philadel-phia: WB. Saunders Company, 1980, 860-868.
3.	Tennent TD, Calder PR, Salisbury RD, et al. The operative management of displaced intra-atticular fractures of the calcaneum: a two centre study using a defined protocol. Injury, 2001, 32: 491-496.
4.	Essex- Lopresti P. The mechanism, reduction technique, and result in fractures of the os calcis. Br J Surg, 1952, 39: 395-419.
5.	Sanders R, Fortin P, DiPasquale A, et al. Operative treatment in 120 displaced intra-articular calcaneal fractures: results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
6.	Lowery RB, Calhoun JH. Fractures of the calcaneus. Part II: Treatment. Foot Ankle Int, 1996, 17: 360-366.
7.	Gurtowski J, Ries MD, Levin PE. Fractures and dislocations of the foot. In: Dee R, Mango E, Hurst L editor(s). Principles of orthopaedic practice. USA: McGraw-Hill Inc, 1989, 1242-1260.
8.	Zwipp H, Rammelt S, Barthel S. Calcaneal fractures: open reduction and internal fixation. Injury, 2004, 35(2) : 46-54.
9.	Rammelt S, Zwipp H. Calcaneus fracture: facts, controversies and recent developments. Injury, 2004, 35(5) : 443-461.
10.	Howard JL,Buckley R,McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17 (4) : 241-249.
11.	Kenwright J. Fractures of the calcaneum. J Bone Joint Surg Br, 1993, 75: 176-177.
12.	Lowery RB, Calhoun JH. Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification. Foot Ankle Int, 1996, 17: 230-235.
13.	Joni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
14.	Parmar HV, Triffitt PD, Gregg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br, 1993, 75( ): 932-937.
15.	O’Farrell DA, O’Byrne JM, McCabe JP, et al. Fractures of the os calcis: improved results with internal fixation. Injury, 1993, 24(4): 263-265.
16.	Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int, 1996, 17(1): 2-9.
17.	Buckley, R, Tough, S, McCormack, R, et al. Operative versus non-operative treatment of displaced intra-articular calcaneal fractures— a prospective randomized controlled multi-center trial. J Bone Joint Surg, 2002, 84: 1733–1744.

1. Sanders R Displaced intra-articular fracture of the calcaneus. J Bone Joint Surg, 2000, 82(2): 225-250.
2. Heppnstall RB. Fracture Treatment and Healing. Philadel-phia: WB. Saunders Company, 1980, 860-868.
3. Tennent TD, Calder PR, Salisbury RD, et al. The operative management of displaced intra-atticular fractures of the calcaneum: a two centre study using a defined protocol. Injury, 2001, 32: 491-496.
4. Essex- Lopresti P. The mechanism, reduction technique, and result in fractures of the os calcis. Br J Surg, 1952, 39: 395-419.
5. Sanders R, Fortin P, DiPasquale A, et al. Operative treatment in 120 displaced intra-articular calcaneal fractures: results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
6. Lowery RB, Calhoun JH. Fractures of the calcaneus. Part II: Treatment. Foot Ankle Int, 1996, 17: 360-366.
7. Gurtowski J, Ries MD, Levin PE. Fractures and dislocations of the foot. In: Dee R, Mango E, Hurst L editor(s). Principles of orthopaedic practice. USA: McGraw-Hill Inc, 1989, 1242-1260.
8. Zwipp H, Rammelt S, Barthel S. Calcaneal fractures: open reduction and internal fixation. Injury, 2004, 35(2) : 46-54.
9. Rammelt S, Zwipp H. Calcaneus fracture: facts, controversies and recent developments. Injury, 2004, 35(5) : 443-461.
10. Howard JL,Buckley R,McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17 (4) : 241-249.
11. Kenwright J. Fractures of the calcaneum. J Bone Joint Surg Br, 1993, 75: 176-177.
12. Lowery RB, Calhoun JH. Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification. Foot Ankle Int, 1996, 17: 230-235.
13. Joni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
14. Parmar HV, Triffitt PD, Gregg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br, 1993, 75( ): 932-937.
15. O’Farrell DA, O’Byrne JM, McCabe JP, et al. Fractures of the os calcis: improved results with internal fixation. Injury, 1993, 24(4): 263-265.
16. Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int, 1996, 17(1): 2-9.
17. Buckley, R, Tough, S, McCormack, R, et al. Operative versus non-operative treatment of displaced intra-articular calcaneal fractures— a prospective randomized controlled multi-center trial. J Bone Joint Surg, 2002, 84: 1733–1744.

《中國循證醫學雜志》

切開復位內固定術與保守治療比較治療移位的跟骨關節內骨折的系統評價

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《中國循證醫學雜志》

切開復位內固定術與保守治療比較治療移位的跟骨關節內骨折的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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