保守治疗与手术治疗踝关节骨折Meta分析

Meta Analysis of Conservative Treatment and Surgical Treatment of Ankle Fractures

目的:系统评价保守治疗与手术切开复位治疗踝关节骨折的疗效。方法:计算机检索外文数据库:PubMed、Cochrane Library、Embase及中文数据库:中国知网、维普、万方所收录的相关文献,检索时间为2010年1月至2019年10月。本研究提取Mazur评分、AOFAS评分、有效率、骨折愈合时间、不良反应及住院费用为评价指标。采用RevMan 5.3软件进行数据分析。结果:共有11篇文献纳入研究,均为随机对照试验,总计1 078例患者,其中保守治疗组537例,手术治疗组541例。结果显示,两组患者Mazur评分[MD=-8.19,95%CI(-11.91,-4.46),P<0.000 01]、AOFAS评分[MD=-7.62,95%CI(-8.50,-6.73),P<0.000 01]、有效率[OR=0.80,95%CI(0.74,0.87),P<0.000 01]等指标比较,差异有统计学意义(P<0.05),手术组优于保守组;两组骨折愈合时间[MD=0.53,95%CI(0.31,076),P<0.000 01]、不良反应[MD=2.82,95%CI(1.46,5.44),P=0.002]这两项指标比较,差异有统计学意义(P<0.05),保守组优于手术组。结论:手术治疗踝关节骨折疗效显著,术后功能恢复好,但受纳入研究数量和质量的限制,上述结论还需更多高质量研究予以证实。

Objective:To evaluate the effect of conservative treatment and surgical open reduction treatment of ankle fracture.Methods:Retrieving relevant documents collected in foreign language databases such as PubMed,Cochrane Library,Em-Base and relevant documents included in Chinese databases such as ChinaNet,Weipu,Wanfang.The retrieval period is from January 2010 to October 2019.In this study,Mazur score,AOFAS score,effective rate,fracture healing time,adverse reactions and hospitalization costs were used as evaluation indicators,using RevMan 5.3 software for data analysis.Results:A total of 11 articles were included in the study,all randomized controlled trials,a total of 1078 patients,including 537 in the conservative treatment group and 541 in the surgical treatment group.The results showed that the Mazur score[MD=-8.19,95%CI(-11.91,-4.46),P<0.00001],AOFAS score[MD=-7.62,95%CI(-8.50,-6.73),P<0.00001],effective[OR=0.80,95%CI(0.74,0.87),P<0.00001]and other indicators,the difference was statistically significant(P<0.05),the surgery group was better than the conservative group;two indicators of fracture healing time[MD=0.53,95%CI(0.31,076),P<0.00001],adverse reactions[MD=2.82,95%CI(1.46,5.44),P=0.002]were compared,the difference was statistically significant(P<0.05),and the conservative group was superior to the surgical group.Conclusion:Surgical treatment of ankle fractures has a significant effect,and postoperative function recovery is good,but limited by the number and quality of included studies,the above conclusions need to be confirmed by more high-quality studies.