缝合锚线和下胫腓螺钉治疗急性下胫腓联合损伤的meta分析

Suture button versus distal tibiofibular syndesmosis screw in treating acute distal tibiofibular syndesmosis injury:a meta analysis

目的通过meta分析探讨缝合锚线(SB)与下胫腓螺钉(SS)治疗急性下胫腓联合损伤临床疗效及术后并发症的差异。方法遵循系统性回顾和荟萃分析原则,通过检索PubMed、OVID医学、Embase数据库、中国知网、万方医学、中国生物医学和维普数据库,纳入所有与SB、SS治疗急性下胫腓联合损伤相关研究,检索时间截至2020年7月19日。设定中文及英文检索策略,严格根据纳入和排除标准筛选文献,对纳入文献和相应的参考文献进行筛选。采用随机对照试验的Cochrane协作评估工具评估偏移风险,确保纳入文献质量。筛选和提取相关结局指标,如术后6个月、1年美国足踝外科协会系统评分(AOFAS评分),踝关节背伸及跖屈角度及术后并发症。使用Rstudio软件对结局指标进行meta分析。结果最终纳入9篇随机对照研究,共536例患者(SB:262例,SS:274例)。所有文献随访率均大于80%,随访时间1.00~2.33年。7篇文献术后6个月AOFAS评分比较,差异有统计学意义[均值差(MD)=3.82,95%可信区间(95%CI):0.94~6.71,P<0.01]。术后1年AOFAS评分比较,差异有统计学意义(MD=4.60,95%CI:1.09~8.12,P=0.01)。SB组患者术后6个月踝关节背伸、跖屈角度优于SS组,但差异均无统计学意义(MD=1.89、3.65,95%CI:-0.27~4.04、-0.43~7.72,P=0.09、0.08)。SB组患者内固定失效率明显低于SS组,差异有统计学意义[优势比(OR)=0.10,95%CI:0.04~0.24,P<0.001];两组患者伤口和感染发生率比较,差异无统计学意义(OR=1.34,95%CI:0.47~3.83,P=0.586);SB组患者内固定局部刺激发生率与SS组比较,差异无统计学意义(OR=0.46,95%CI:0.13~1.62,P=0.228)。结论SB组患者术后6个月、1年AOFAS评分更高,手术内固定失效率更低。

Objective To explore the difference of clinical efficacy and complications between the suture button(SB)and the distal tibiofibular syndesmotic screw(SS)in the treatment of acute tibiofibular syndesmosis injury.Methods According to the principle of systematic review and meta-analysis,PubMed,OVID Medicine,Embase database,CNKI,Wanfang,China biomedicine and VIP database were retrieved to include all studies related to the treatment of acute distal tibiofibular syndesmosis injury with SB and distal tibiofibular SS.The retrieval time was ended until July 19,2020.Chinese and English retrieval strategy was set,the articles were screened strictly according to the inclusion and exclusion criteria and the entering group articles and corresponding reference literature were screened.The Cochrane collaborative assessment tool for randomized controlled trials(RCT)was used to assess the risk of bias and ensure the quality of the included literature.Screening and extracting the related outcome indicators:AOFAS score in postoperative 6 months and 1 year,ankle dorsiflexion angle and postoperative complications.All outcome indicators were analyzed by using Rstudio software.Results Nine RCTs were finally included,involving 536 patients(SB:262 cases,SS:274 cases).The follow-up rate in all articles was more than 80%,and the follow-up time of each article was 1.00-2.33 years.The AOFAS score of 7 articles in postoperative 6 months had statistically significant differences(MD=3.82,95%CI:0.94-6.71,P<0.01).The AOFAS score in postoperative 1 year had statistically significant difference(SB)(MD=4.60,95%CI:1.09-8.12,P=0.01).The ankle dorsiflexion and plantar flexion angle in postoperative 6 months in the SB group were better than those in the SS group,but the difference was not statistically significant.The failure rate of internal fixation in the SB group was lower than that in the SS group with statistical difference(OR=0.10,95%CI:0.04-0.24,P<0.001);there was no difference in wound complications and infection between the two groups(OR=1.34,95%CI:0.47-3.83,P=0.586);the incidence rate of local stimulation in internal fixation had no difference between the SB group and SS group(OR=0.46,95%CI:0.13-1.62,P=0.228).Conclusion The AOFAS score in postoperative 6 months and 1 year in the SB group was higher,and the failure rate of operative internal fixation was lower.