切开复位内固定植骨与不植骨治疗移位型跟骨关节内骨折的Meta分析

Open reduction and internal fixation with or without bone graft for intra-articular calcaneal fractures:a meta-analysis

目的比较切开复位内固定植骨与不植骨治疗移位型跟骨关节内骨折的临床疗效。方法使用计算机检索Pub Med、Embase、Conchrane Libray数据库中关于移位型跟骨关节内骨折采用切开复位内固定植骨与不植骨治疗的随机对照试验或病例对照研究。检索时间限定为建库至2017-04,同时查阅所获取的参考文献索引。分别由2位研究员单独进行质量评价及数据提取。主要评价指标:术后足功能优良率(AOFAS踝与后足功能评分,Maryland足部功能评分)、Bohler角、Gissane角、跟骨高度及简明健康调查量表(SF-36)评分。次要评价指标:术后切口感染、切口坏死及裂开、骨性关节炎。结果纳入定性及定量合成文献共7篇,2组共824例,植骨组399例。Meta分析表明:末次随访2组术后足功能优良率、Bohler角、Gissane角、跟骨高度、术后切口坏死或裂开、切口感染及骨性关节炎比较差异无统计学意义(P>0.05);植骨组SF-36评分优于不植骨组,差异有统计学意义(P<0.05)。结论结合Meta分析结果 ,加之植骨导致自体植骨者供区术后的疼痛,因此,对于移位型跟骨关节内骨折,植骨不是必要的。

Objective To compare the clinical efficacy of open reduction and internal fixation with or without bone grafttreatment for displaced intra-articular calcaneal fractures. Methods The following electronic database was searched：PubMed, Embase and Conchrane Libray database. The time limit was from the establishing of the database to April 2017.Main evaluation index included excellent rate of foot function, Bohler angle, Gissane angle, calcaneus height, SF-36.Secondary evaluation index included incision necrosis or dehiscence, wound infection and osteoarthritis. The Review Manager5.3 software was used for Meta-analysis. Results There were seven articles in qualitative and quantitative synthesis, twogroups of a total of 824 cases, 399 cases of bone graft. The Meta analysis showed that bone graft group and non bone graftgroup were not statistically significantly different at the end of follow-up （excellent rate of foot function, Bohler angle, Gissaneangle, calcaneus height, incision necrosis or dehiscence,wound infection and osteoarthritis）. There was statistically significantdifference in SF-36. Conclusion According to meta analysis results, considering bone grafts leading to higher hospital costsor pain in donor site after autologous bone graft, bone graft is not essential for displaced intra-articular calcaneus fractures.