关节镜手术与开放手术治疗慢性踝关节外侧不稳的临床疗效和安全性Meta分析

Clinical curative effects and safety of arthroscopic surgery versus open surgery for treatment of chronic lateral ankle instability:a meta-analysis

目的:比较关节镜手术与开放手术治疗慢性踝关节外侧不稳的临床疗效和安全性。方法:应用计算机检索中国知网、万方数据库、Pubmed、Cochrane library及Embase,搜集关节镜手术(关节镜组)与开放手术(开放手术组)治疗慢性踝关节外侧不稳的对比研究文献,检索时限均为建库至2020年4月。文献检索、筛选、数据提取及偏倚风险评价后,采用RevMan5.3软件对踝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分、Karlsson踝关节评分、距骨倾斜角、前抽屉试验及并发症发生率进行Meta分析。结果:共纳入6篇文献,其中随机对照试验文献1篇、非随机对照试验文献5篇。Meta分析结果显示,术后2组患者踝关节疼痛VAS评分、AOFAS踝与后足评分、Karlsson踝关节评分、距骨倾斜角、前抽屉试验及并发症发生率的组间差异均无统计学意义[I^(2)=74%,SMD=-0.43,95%CI(-1.09,0.23),P=0.210;I^(2)=0%,SMD=0.26,95%CI(-0.02,0.55),P=0.070;I^(2)=68%,SMD=0.17,95%CI(-0.35,0.69),P=0.520;I^(2)=0%,SMD=0.13,95%CI(-0.24,0.50),P=0.480;I^(2)=0%,SMD=-0.07,95%CI(-0.42,0.28),P=0.710;I^(2)=0%,OR=0.53,95%CI(0.15,1.91),P=0.330]。结论:现有的证据表明,关节镜手术与开放手术治疗慢性踝关节外侧不稳的临床疗效及安全性相当。

Objective:To compare the clinical curative effects and safety of arthroscopic surgery versus open surgery in treatment of chronic lateral ankle instability(CLAI).Methods:All articles about arthroscopic surgery(arthroscopic surgery group)versus open surgery(open surgery group)for treatment of CLAI included from database establishing to April 2020 were retrieved from China National Knowledge Internet, WanFang Database, Pubmed, Cochrane Library and Embase through computer.The articles were retrieved and screened, the information was extracted and the bias risk of included researches in the articles was assessed, followed by Meta-analysis on ankle pain visual analogue scale(VAS)score, American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score, Karlsson ankle score, talar tilt angle(TTA),anterior drawer test(ADT)and complication incidence by using RevMan5.3 software.Results:Six articles were included in the final analysis, including 1 randomized controlled trial(RCT)article and 5 non-RCT articles.The results of Meta-analysis demonstrated that there was no statistical difference in ankle pain VAS score, AOFAS ankle-hindfoot score, Karlsson ankle score, TTA,ADT and complication incidence between the 2 groups after the surgery(I;=74%,SMD=-0.43,95%CI(-1.09,0.23),P=0.210;I;=0%,SMD=0.26,95%CI(-0.02,0.55),P=0.070;I;=68%,SMD=0.17,95%CI(-0.35,0.69),P=0.520;I;=0%,SMD=0.13,95%CI(-0.24,0.50),P=0.480;I;=0%,SMD=-0.07,95%CI(-0.42,0.28),P=0.710;I;=0%,OR=0.53,95%CI(0.15,1.91),P=0.330).Conclusion:Available evidences suggest that the arthroscopic surgery is similar to open surgery in clinical curative effects and safety in treatment of CLAI.