作者：Barbara Boughton 齣處：WebMD醫學新聞　　February 13, 2009 — 根據發錶在2月14日Lancet期刊的隨機分派研究結果 為期10天的膝下石膏固定或空氣石膏 膝下石膏對腳踝扭傷的快速復原最佳 - 趣味新聞網

發表日期 2009-03-02T08:16:42+08:00

     本帖最後由 goodcat1111 於 2009-3-18 23:33 編輯

作者：Barbara Boughton
齣處：WebMD醫學新聞

February 13, 2009 — 根據發錶在2月14日Lancet期刊的隨機分派研究結果，為期10天的膝下石膏固定或空氣石膏（Aircast），相較於目前在嚴重腳踝扭傷後的標準固定方式，復原的速度更快。

研究收納584位病患，這些病患在英國的八個急診部門接受診治，以長骨壓迫綳帶與膝下石膏、空氣石膏矯正器、Bledsoe靴固定，預後在第三與第九個月時評估。

隻使用膝下石膏的病患，在第三個月時的腳踝功能、疼痛改善、癥狀與活動力恢復地較佳；然而，空氣石膏矯正器在減輕疼痛或癥狀，或是對病患活動力的影響則顯示沒有任何好處；在第三個月評估時，相較於長骨固定，在腳踝功能上有顯著改善。

相較於普遍的臨床選擇，對於促進快速復原來說，一段時間的固定是最有效的策略。英國Coventry市Warwick大學Warwick醫學院Warwick臨床研究單位的Sarah E. Lamb博士與其同事錶示，這最好以膝下石膏來達成。空氣石膏矯正器是膝下石膏另一個好的替代選擇。Bledsoe靴的研究結果是最令人失望的，尤其是該裝置需要支付額外費用。長骨壓迫綳帶是目前最常使用來研究的，但是最糟的治療。

研究者的結論是，相較於長骨壓迫綳帶而言，膝下石膏對於治療嚴重腳踝扭傷的臨床醫師們來說是最好的選擇，因為這可以加快恢復速度、減輕癥狀或是幫助病患迴復功能。根據作者錶示，這些優點對於治療嚴重腳踝扭傷來說尤其重要，因為這些癥狀可能造成嚴重失能，或是拖延癥狀長達數月或數年。因為這項研究中所看到的好處，作者們建議將膝下石膏作為嚴重腳踝扭傷的第一綫治療選擇。

在這項研究中，當與長骨壓迫綳帶比較時，膝下石膏在三個月時腳踝功能的平均差異達到9%（95%信賴區間為2.4%-15.0%），當空氣石膏矯正器與長骨壓迫綳帶相比時，腳踝功能品質差異為8%（95%信賴區間為1.8%-14.2%）。

根據研究者們錶示，三個月時的結果對於評估不同治療之間的相對強度來說是特彆重要的，因為嚴重腳踝扭傷大部分在前六個月會恢復。

這項研究發現，當病患在第九個月時接受評估，之間並無太大差異。

在隨後的主編評論中，來自夏洛特斯維爾維吉尼亞大學的Jay Hertel博士錶示，研究發現比較可能將這個問題認為是懸而未決，因為對於腳踝扭傷已確立的臨床共識強調功能性治療，而非僅是固定。他也指齣，作者們並未報告這四組再發性腳踝扭傷的發生率，這可能展現齣膝下石膏的長期臨床好處。

這項研究的其他限製，包括研究者們並未評估正確支持處理的長期順從性，除瞭病患自行報告的之外，隨機分派為瞭要確認損傷嚴重度以及在支持處理之前讓一開始的腫脹消除，而有三天的延遲。

Hertel博士錶示這項研究的發現令人注目，研究結果對於目前急性腳踝扭傷病患積極功能性治療的標準處理方法提齣瞭更多疑問。

Below-Knee Cast Best for Rapid Recovery From Ankle Sprain

By Barbara Boughton
Medscape Medical News

February 13, 2009 — A 10-day period of immobilization in a below-knee cast or Aircast results in a more rapid recovery from ankle sprain compared with the current clinical practice of mobilization after a severe ankle sprain, according to a randomized controlled trial reported in the February 14 issue of The Lancet.

In a trial of 584 patients treated at 8 emergency departments across the United Kingdom, support with tubular compression bandage was compared with a below-knee cast, Aircast brace, and Bledsoe boot, and outcomes were assessed at 3 and 9 months.

Only the below-knee cast resulted in significantly better ankle function as well as improvements in pain, symptoms, and activity at 3 months. While the Aircast brace did not show any benefits in lessening pain or symptoms or patient activity, it produced a significant improvement in ankle function when compared with tubular compression bandage at 3 months.

"Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery. This was achieved best by the application of a below-knee cast," write Sarah E. Lamb, DPhil, from the Warwick Clinical Trials Unit, Medical School, University of Warwick, Coventry, United Kingdom, and colleagues. "The Aircast brace was a suitable alternative to below-knee casts. Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device. Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently the worst treatment."

The researchers conclude that below-knee cast is a better choice for clinicians treating severe ankle sprains than tubular compression bandage because it aids recovery, lessens symptoms, and helps patients return to normal function. These advantages are especially important in treating severe ankle sprain because the condition can result in severe incapacity and lingering symptoms for months or years, according to the study authors. They recommend a below-knee cast as the first-choice treatment for severe ankle sprain, because of the range of benefits seen in the study.

When compared with tubular compression bandage, the below-knee cast resulted in a 9% mean difference in ankle function at 3 months (95% confidence interval [CI], 2.4% – 15.0%) in the study. There was an 8% mean difference in quality of ankle function when the Aircast brace was compared with tubular compression bandage (95% CI, 1.8% – 14.2%).

The 3-month results are especially important in assessing the relative strengths of different treatments because most recovery from severe ankle sprains occurs within the first 6 months, according to the researchers.

The study found that there was little difference between any of the 4 treatments when patients were assessed at 9 months.

In an accompanying editorial, Jay Hertel, PhD, from the University of Virginia in Charlottesville, notes that the study's findings are likely to be viewed as controversial, because established clinical consensus on ankle sprains have emphasized functional treatment rather than immobilization. He also points out that the authors did not report on the incidence of recurrent ankle sprains in the 4 groups, which could have illuminated the long-term clinical benefits of below-knee casting.

Other limitations of the study were that the researchers were not able to measure long-term compliance with the supports accurately, except by patient self-report, and the presence of a 3-day delay before randomization in order to confirm injury severity and allow initial swelling to decrease before using a support.

Yet Dr. Hertel notes that the findings of the study are both provocative and compelling. "The results of the study call into question the current standard of aggressive functional treatment of patients recovering from acute ankle sprains," he writes.

Lancet. 2009;373:524-525, 575–581.

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