不同方法修复足跟部软组织缺损的Meta分析

A meta-analysis of different flaps for the soft tissue defect of the heel

[目的]利用Meta分析的方法总结足跟部软组织缺损修复方法的选择,定量比较腓肠神经营养血管皮瓣和其他皮瓣修复足跟部软组织缺损的效果。[方法]以"腓肠神经"、"足跟"、"外科皮瓣"、"heel defects"等检索词收集与研究问题相关的所有文献,按照制定的纳入标准分别选择符合纳入标准的文献。提取纳入文献的数据信息,对资料进行异质性检验,计算效应合并值的点估计及其区间估计。[结果]腓肠神经营养血管皮瓣和其他各种皮瓣转移修复足跟部缺损并发症发生率合并OR值为2.81,95%CI为[1.37,5.78],P=0.005。感觉恢复比较合并OR值为0.63,95% CI为[0.06,7.24],P=0.71。耐磨度比较合并OR值为1.04,95%CI为[0.38,2.80],P=0.94。腓肠神经营养血管皮瓣和足部皮瓣转移修复足跟部缺损并发症发生率合并OR值为4.02,95%CI为[1.38,11.76],P=0.01。腓肠神经营养血管皮瓣和游离皮瓣转移修复足跟部缺损并发症发生率合并OR值为1.83,95%CI为[0.68,4.91],P=0.23。[结论](1)足跟部软组织的修复应遵循一定的原则;(2)腓肠神经-小隐静脉营养血管皮瓣血供充足,切取方便,不牺牲主要血管,是修复足跟部损伤的良好选择。

[ Objective] To summarize procedures for soft tissue defect of the heel using meta-analysis and to evaluate the effectiveness of suralneuroeutaneous and other flaps using quantitative methods and statistical analysis. [ Method ] The terms ＂ sural nerve,＂ ＂heel defects,＂ and ＂surgical flaps＂ were searched via multiple channels to obtain maximum number of articles with related research. However,case reports, animal experiments, anatomical studies, reviews, and other types of literature were excluded. In accordance wittl the established inclusion criteria, quality assessment of the literature bad been already performed. Data from the literature were extracted, and data from eligible studies were tabulated for meta-analysis and were then subjected to a heterogeneity test. According to the results of＂ the heterogeneity test, the fixed effects or the random effects model was select-ed, and the combined effect of point estimation and interval values was estimated. [ Result] （ 1 ） The suralneuroeutaneous flap and other flap groups in which complications occurred had combined odds ratio （OR） ,2.81,95% confidence interval （95% CI） [ 1.37 - 5.78 ] ,P = 0. 005. The results for sensory recovery were combined OR,0.63,95 % CI I 0.06 - 7.24 ] , P = 0.71, and that for abrasion resistance were combined OR, 1.04,95 % CI, [ 0.38-2.80 ] ,P = 0.94. The suralneurocutaneous flap and foot flap groups in which complications occurred had combined OR,4.02,95 % CI [ 1.38 - 11.76 ] ,P = 0.01. The suralneuroeu-taneous and free flap groups in which complications occurred had combined OR, 1.83,95% CI [ 0.68 - 4.91 ] , P = 0.23. [ Conclusion ] （ 1 ） The repairing of the heel follows a certain principle. （2） The suralneurocutaneous flap allows adequate blood supply, and this flap can be easily and conveniently excised without sacrificing any major artery, therefore, it is a good choice for treating injuries in the lower leg, ankle, or foot.