腓骨肌腱滑脱手术方式选择的Meta分析

Selection of surgical methods for peroneal tendon subluxation:a Meta analysis

目的:评价目前治疗腓骨肌腱滑脱的几种手术方法的效果。方法:在中国知网、万方数据知识服务平台、维普数据库、Embase、PubMed、Cochrane Library和Web of Science中检索手术治疗腓骨肌腱滑脱的研究。按照纳入标准和排除标准筛选文献并进行文献质量评价,统计文献基本信息、患者性别、年龄、致伤原因、术后复发和并发症情况。用RevMan5.4软件作单组率的Meta分析并确定术后复发率和术后并发症发生率的95% CI。对术前与末次随访时美国足踝外科协会(AOFAS)评分、术后复发率和术后并发症发生率进行箱式图统计描述。 结果:共纳入32篇文献(37项研究),690例患者,男女比例约为2.8∶1。共27项研究记录致伤原因,包括498例患者,其中运动损伤397例(79.7%)。将纳入的研究根据手术方式分为四组:腓骨沟加深组(12项研究,228例)、腓骨上支持带(SPR)修复或重建组(13项研究,259例)、骨性阻挡组(6项研究,119例)和肌腱重排列组(6项研究,84例)。术后复发率各组的95% CI:腓骨沟加深组为0.0004(0.0000,0.0080),SPR修复或重建组为0.0121(0.0025,0.0286),骨性阻挡组为0.0321(0.0081,0.0711),肌腱重排列组为0.0010(0.0049,0.0194);术后并发症发生率各组的95% CI:腓骨沟加深组为0.0223(0.0009,0.0711),SPR修复或重建组为0.0476(0.0195,0.0873),骨性阻挡组为0.1376(0.0435,0.2732),肌腱重排列组为0.1112(0.0100,0.3003)。各组95% CI均有重叠,术后复发率和术后并发症发生率组间差异均无统计学意义( P>0.05)。共24项研究具备完整AOFAS评分数据,箱式图显示各项研究术后AOFAS评分较术前均显著提升。箱式图显示腓骨沟加深组术后复发率低于其他三组,SPR修复或重建组术后并发症发生率低于其他三组。 结论:对于腓骨肌腱滑脱,手术治疗总体效果较好,腓骨沟加深和SPR修复或重建可作为首选术式,而采用骨性阻挡或肌腱重排列法时需警惕术后并发症。

Objective To evaluate the efficacy of several existing surgical methods for peroneal tendon subluxation.Methods China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform,VIP database,Embase,PubMed,Cochrane Library and Web of Science were searched for the researches on the surgical treatment of peroneal tendon subluxation.All retrieved papers were screened according to the inclusion and exclusion criteria,followed by quality assessment of the papers,and documentation of the basic information of the papers and gender,age,cause of injury,postoperative recurrence and complications of the patients.A single-group meta-analysis was conducted using software RevMan 5.4,and the 95%CI for the recurrence rate and postoperative complication rate was determined.Box plots were used to statistically describe the American Orthopedic Foot and Ankle Society(AOFAS)score before surgery and at the last follow-up,postoperative recurrence rate,and postoperative complication rate.Results A total of 32 papers(37 studies)containing 690 patients were included,with a male-to-female ratio of about 2.8:1.The cause of injury was recorded in a total of 27 studies involving 498 patients,397(79.7%)of whom had sports injuries.The included studies were divided into four groups according to the surgical methods:fibular groove deepening group(12 studies,228 patients),superior peroneal retinaculum(SPR)repair or reconstruction group(13 studies,259 patients),bone block group(6 studies,119 patients),and tendon rerouting group(6 studies,84 patients).The 95%CI for the postoperative recurrence rate was 0.0004(0.0000,0.0080)in the fibular gro0ve deepening group,0.0121(0.0025,0.0286)in the SPR repair or reconstruction group,0.0321(0.0081,0.0711)in the bone block group and 0.0010(0.0049,0.0194)in the tendon rerouting group;The 95%CI for the postoperative complication rate was 0.0223(0.0009,0.0711)in the fibular groove deepening group,0.0476(0.0195,0.0873)in the SPR repair or reconstruction group,0.1376(0.0435,0.2732)in the bone block group and 0.1112(0.0100,0.3003)in the tendon rerouting group.There was an overlap of the 95%CI in all the groups and the differences in the postoperative recurrence and postoperative complication rates were not statistically significant among the groups(P>0.05).A total of 24 studies had complete AOFAS data,and the box plot showed that the postoperative AOFAS scores were significontly improved in each study compared with those before surgery(P<0.05).Box plots showed that the postoperative recurrence rate in the fibular groove deepening group was lower than that of the other three groups and the postoperative complication rate in SPR repair or reconstruction group was lower than that of the other three groups.Conclusion In the surgical treatment of peroneal tendon subluxation,the overall prognosis is good,with fibular groove deepening and SPR repair or reconstruction as the preferred surgical choices,whereas postoperative complications may occur while using the surgical methods of bone block or tendon rerouting.