• 新疆醫(yī)科大學(xué)第一附屬醫(yī)院骨科（烏魯木齊 830054）;

目的 　比較切開(kāi)復(fù)位內(nèi)固定術(shù)與保守治療移位跟骨關(guān)節(jié)內(nèi)骨折的臨床療效。
方法 　收集所有切開(kāi)復(fù)位內(nèi)固定術(shù)與保守治療比較治療移位跟骨關(guān)節(jié)內(nèi)骨折的隨機(jī)對(duì)照試驗(yàn)（RCT），按Cochrnae協(xié)作網(wǎng)標(biāo)準(zhǔn)逐個(gè)進(jìn)行質(zhì)量評(píng)價(jià)和Meta分析。
結(jié)果 　共納入4篇RCT，包括530例患者。4個(gè)研究顯示，在返回原來(lái)工作崗位、距下關(guān)節(jié)活動(dòng)范圍、Bohler’s角的恢復(fù)上，切開(kāi)復(fù)位內(nèi)固定術(shù)優(yōu)于保守治療。在足跟殘留疼痛方面，兩種方法的差異無(wú)統(tǒng)計(jì)學(xué)意義。而其治療效果評(píng)分因不同研究采用的結(jié)局評(píng)價(jià)標(biāo)準(zhǔn)不同，無(wú)法進(jìn)行合并分析。
結(jié)論 　切開(kāi)復(fù)位內(nèi)固定術(shù)與保守治療均是有移位的跟骨關(guān)節(jié)內(nèi)骨折的有效治療方法。切開(kāi)復(fù)位內(nèi)固定術(shù)在返回原來(lái)工作崗位、距下關(guān)節(jié)活動(dòng)范圍、Bohler’s角的恢復(fù)上優(yōu)于保守治療。兩種方法在足跟殘留疼痛方面無(wú)差別。因本研究的樣本量太小，納入的研究數(shù)量少，方法學(xué)質(zhì)量不高，缺乏足夠的證據(jù)，尚需更多設(shè)計(jì)嚴(yán)格的研究以增加證據(jù)的強(qiáng)度。

引用本文： 王翀,田禾,屈建華,田征. 切開(kāi)復(fù)位內(nèi)固定術(shù)與保守治療比較治療移位的跟骨關(guān)節(jié)內(nèi)骨折的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2007, 07(4): 276-282. doi: 復(fù)制

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.
  1. 1. Sanders R Displaced intra-articular fracture of the calcaneus. J Bone Joint Surg, 2000, 82(2): 225-250.
  2. 2. Heppnstall RB. Fracture Treatment and Healing. Philadel-phia: WB. Saunders Company, 1980, 860-868.
  3. 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. 4. Essex- Lopresti P. The mechanism, reduction technique, and result in fractures of the os calcis. Br J Surg, 1952, 39: 395-419.
  5. 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. 6. Lowery RB, Calhoun JH. Fractures of the calcaneus. Part II: Treatment. Foot Ankle Int, 1996, 17: 360-366.
  7. 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. 8. Zwipp H, Rammelt S, Barthel S. Calcaneal fractures: open reduction and internal fixation. Injury, 2004, 35(2) : 46-54.
  9. 9. Rammelt S, Zwipp H. Calcaneus fracture: facts, controversies and recent developments. Injury, 2004, 35(5) : 443-461.
  10. 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. 11. Kenwright J. Fractures of the calcaneum. J Bone Joint Surg Br, 1993, 75: 176-177.
  12. 12. Lowery RB, Calhoun JH. Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification. Foot Ankle Int, 1996, 17: 230-235.
  13. 13. Joni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
  14. 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. 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. 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. 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.