手术治疗与保守治疗对移位型跟骨关节内骨折临床疗效比较的Meta分析

Meta-analysis on clinical outcomes of surgery versus nonsurgical treatment for displaced intraarticular calcaneal fractures

目的对国内外有关手术治疗与保守治疗移位型跟骨关节内骨折的的研究文献进行分析,评价它们临床疗效及安全性。方法计算机检索Cochrane图书馆、Pud Med、Ovid、Elesive、CNKI等数据库。检索从(1969-06-04,2014-06-04)年有关手术治疗与保守治疗比较治疗移位型跟骨关节内骨折的随机对照试验(RCTs),筛选出符合纳入标准的文献,并对其进行严格的质量评价。利用Cochrane协作网提供的Rev Man 5.0软件对纳入研究结果进行Meta分析,并对数据进行异质性检验。结果共纳入9篇,手术组382例,保守组389例,Meta分析结果显示,与保守组比较,手术组穿鞋方式改变者的例数少(P<0.05),总并发症发生率低(P<0.05),不能恢复原工作者的例数少(P<0.05),距下关节融合例数少(P<0.05);在Bhler角度变化程度上保守组与手术组比较中,手术组恢复的更好(P<0.05)。但在患肢足跟残痛发生的例数、AOFAS评分、距下关节运动范围<50%发生的例数和跟骨恢复高度方面,两组的差异无统计学意义。结论综合考虑在恢复跟骨解剖结构,更好的康复效果及更少的并发症发生方面,手术治疗应是其最佳选择。

Objective To analyze both the English and Chinese literatures of surgery versus nonsurgical treatment for displacement intra-articular calcaneal fractures（ DIACF）,and to evaluate the clinical outcomes and safety. Methods Five electronic databases（ Pud Med,Ovid,Elesive,Cochrane library and CNKI） were systematically searched to identify randomised controlled trials（ RCTs） in which surgical treatment was compared with nonsurgical treatment for DIACF from 1969 /06 /04 to 2014 /06 /04.The literatures＇ quality was strictly assessed. The analysis was performed with software Rev Man5. 0 from the Cochrane collaboration. The heterogeneity of data was also checked. Results Nine studies with a total of771 participants were enrolled. The surgical group consisted of 382 patients,and the nonsurgical group consisted of 389 patients. The results showed that the surgical treatment was superior to nonsurgical treatment in the rate of complications（ P〈 0. 05）,the case number of subtalar joint fusion（ P〈 0. 05）,the problem in wearing shoes（ P〈 0. 05）,the case number of resuming pre-injury work（ P〈 0. 05）,and in the changes of Bhler angle（ P〈 0. 001）. No significant difference was identified between the two methods regarding the rate of residual pain,American Orthopaedic Foot and Ankle Society（ AOFAS）scores,cases with subtalar joint movement range 50%,and calcaneal height restoration. Conclusion According to this Meta-analysis,surgical treatment for DIACF may be superior to nonsurgical treatment in reconstruction of anatomical structures,social function recovery and reducing the complication incidence,which is the best choice.