Lisfranc损伤切开复位内固定与一期部分跖跗关节融合术临床疗效的Meta分析

Open reduction and internal fixation and primary partial arthrodesis in treatment of Lisfranc joint injuries: a Meta analysis

目的通过Meta分析,比较Lisfranc损伤切开复位内固定术(ORIF)与一期部分跖跗关节融合术的临床疗效。方法通过检索中英文数据库,收集全部对Lisfranc损伤进行ORIF及一期部分跖跗关节融合术进行比较的临床研究,并对其进行质量评价及Meta分析。评价指标:功能评分、并发症、二次翻修手术、内固定物取出术、患者满意率。结果共纳入4篇文献,其中2篇前瞻性随机对照研究,2篇回顾性队列研究。功能评分因缺乏统一评分系统未能进行合并。ORIF组与关节融合组在并发症方面差异没有统计学意义[RR=0.85,95%CI(0.06,11.25),P=0.90]。ORIF组与关节融合组在二次翻修手术方面差异没有统计学意义[RR=0.42,95%CI(0.14,1.29),P=0.13]。关节融合组在内固定物取出术方面比较明显优于ORIF组[RR=0.04,95%CI(0.01,0.12),P<0.000 01]。关节融合组患者满意率较ORIF组高,差异有统计学意义[RR=4.69,95%CI(1.80,12.22),P=0.002]。结论 Lisfranc损伤一期行关节融合术在术后并发症、二次翻修手术方面与切开复位内固定术无明显差异,但在患者满意率及内固定取出方面更有优势。

Objective To compare the efficacy of open reduction and internal fixation（ORIF） and primary partial arthrodesis in the treatment of Lisfranc joint injuries through Meta analysis. Methods A comprehensive Meta analysis was performed for primary arthrodesis and ORIF in treatment of Lisfranc joint injuries by searching and retrieving all articles English and Chinese. Results A total of 4 studies,including 2 randomized controlled trials and 2 clinical trials,were qualified for Meta analysis in aspect of function evalution,complications,second orthopedic surgery,removing internal fixation and satisfaction of patients. There was no significant difference in the incidence of complications between ORIF and primary arthrodesis [ RR =0.85,95% CI（0.06,11.25）,P =0.90],there was no significant difference in the revision surgery too [RR =0.42,95% CI（0.14,1.29）,P =0.13]. Compared with ORIF,primary arthrodesis was better in removing the internal fixation [RR =0.04,95%CI（0.01,0.12）,P〈 0.000 01]. The satisfaction in ORIF was lower than arthrodesis[RR =4.69,95%CI（1.80,12.22）,P =0.002].Conclusion Primary arthrodesis is better in satisfaction of patients and removing the internal fixation than ORIF,but not better in postoperative complications and the revision surgery.