目的:本系统综述旨在分析早期负重与晚期负重对踝关节骨折后康复效果的影响。主要包括踝关节功能评分,恢复工作/日常生活的时间和并发症发生率。
方法:中国国家知识基础设施,万方数据知识服务平台,中国科学技术学报,WebofScience,PubMed,检索了Embase和Cochrane图书馆数据库。重点是确定以早期负重干预治疗踝关节骨折术后康复为中心的随机对照试验。搜索所有数据库,查找从数据库开始到2023年6月20日期间发表的合格研究。根据纳入标准筛选符合条件的研究。使用Cochrane干预措施系统评估手册推荐的方法评估研究质量。两位作者独立进行了文献检索和数据提取。使用ReviewManager5.3对符合条件的研究进行荟萃分析。根据本文研究报告的术后踝关节功能的时间点,我们决定在术后6周进行踝关节功能评分的荟萃分析,术后12周,术后24-26周和术后1年。
结果:共11篇论文,包括862名患者,包括在内。荟萃分析表明,接受早期负重干预的患者,指术后6周负重,脚踝功能评分的经验增强(Olerud-Molander评分,AOFAS评分或Baird-Jackson评分)在各种术后里程碑:6周(SMD=0.69,95%CI:0.49-0.88且p<0.01),12周(SMD=0.57,95%CI:0.22-0.92,p<0.01)和24-26周范围(SMD=0.52,95%CI:0.20-0.85,p<0.01)。亚组分析的结果表明,早期负重干预的效果受踝关节运动范围的影响。此外,早期负重可以让患者更早地回到日常生活和工作中,通过恢复受伤前活动的时间进行评估(MD=-2.74,95%CI:-3.46至-2.02,p<0.01),并发症发生率无明显升高(RR=1.49,95%CI:0.85-2.61,p>0.05)。
结论:结果表明,早期负重可有效改善踝关节骨折术后患者的踝关节功能,并使患者更早恢复日常生活。重要的是,早期负重的安全性仍然有利,没有比晚期负重更高的并发症风险。
OBJECTIVE: This systematic
review aimed to analyse the effect of early weight bearing versus late weight bearing on rehabilitation outcomes after ankle fractures, which primarily include ankle function scores, time to return to work/daily life and complication rates.
METHODS: The China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal, Web of Science, PubMed, Embase and Cochrane Library databases were searched. The focus was on identifying randomised controlled trials centred on early weight-bearing interventions for post-operative ankle fracture rehabilitation. All databases were searched for eligible studies published within the period from database inception to 20 June 2023. The eligible studies were screened according to the inclusion criteria. Study quality was evaluated using the methodology recommended by the Cochrane Handbook for the Systematic Evaluation of Interventions. Two authors independently performed the literature search and data extraction. Eligible studies were subjected to meta-analyses using
Review Manager 5.3. Based on the time points at which post-operative ankle function was reported in the studies included in this paper, we decided to perform a meta-analysis of ankle function scores at 6 weeks post-operatively, 12 weeks post-operatively, 24-26 weeks post-operatively and 1 year post-operatively.
RESULTS: A total of 11 papers, comprising 862 patients, were included. Meta-analysis indicated that patients receiving early weight-bearing interventions, which referred to weight-bearing for 6 weeks post-operatively, experienced enhancements in ankle function scores (Olerud-Molander score, AOFAS score or Baird-Jackson score) at various post-operative milestones: 6 weeks (SMD = 0.69, 95% CI: 0.49-0.88 and p < 0.01), 12 weeks (SMD = 0.57, 95% CI: 0.22-0.92 and p < 0.01) and the 24-26 weeks range (SMD = 0.52, 95% CI: 0.20-0.85 and p < 0.01). The results of subgroup analyses revealed that the effects of early weight-bearing interventions were influenced by ankle range-of-motion exercises. Additionally, early weight bearing allows patients to return to daily life and work earlier, which was evaluated by time when they resumed their preinjury activities (MD = -2.74, 95% CI: -3.46 to -2.02 and p < 0.01), with no distinct elevation in the incidence of complications (RR = 1.49, 95% CI: 0.85-2.61 and p > 0.05).
CONCLUSIONS: The results showed that early weight bearing is effective in improving ankle function among post-operative ankle fracture patients and allows patients to return to daily life earlier. Significantly, the safety profile of early weight bearing remains favourable, with no higher risk of complications than late weight bearing.