跟骨骨折六种手术入路术后并发症发生率网状荟萃分析

Postoperative complication rates of six surgical approaches for calcaneal fractures: a network meta-analysis

[目的]应用网状荟萃分析方法比较6种跟骨骨折开放复位内固定手术入路术后并发症发生率,为临床决策提供依据。[方法]计算机检索知网、万方、维普、CBM、Pubmed、Embase、Cohrane Library等数据库,查找相关的临床研究,检索时限均为建库至2018年09月01日。采用R 3.3.3和Stata 18.0软件进行网状荟萃分析。[结果]共检索到2 637篇相关文献,经按纳入与排除标准筛选,最终纳入14篇文献。14篇文献共研究1 011足,所有患者均为Sanders II^IV型跟骨骨折,其中采用传统L形切口501足、跗骨窦切口338足、八字形切口89足、横弧形切口40足、直形切口29足、斜形切口14足。跗骨窦切口的术后并发症发生率低于传统L形切口(RR=0.28,95%CI:0.18~0.44);八字形切口的术后并发症发生率低于传统L形切口(RR=0.17,95%CI:0.04~0.62);横弧形切口的术后并发症发生率低于传统L形切口(RR=0.17,95%CI:0.04~0.75);直形切口的术后并发症发生率低于传统L形切口(RR=0.19,95%CI:0.06~0.58);斜形切口的术后并发症发生率与传统L形切口相当(RR=0.64,95%CI:0.14~3.02)。按照概率排序法,并发症发生率从高到低排序为:斜形切口>传统外侧L形切口>横弧形切口>直形切口>跗骨窦切口>八字形切口。[结论]本研究表明八字形切口的术后并发症风险最低,但手术切口的选择需要结合患者具体情况。因受纳入研究数量和质量的限制,仍待多中心大样本研究予以佐证。

[Objective]To compare the postoperative complications rates of 6 approaches for open reduction and internal fixation of calcaneus fracture by a network meta-analysis,and provide the basis for clinical decision-making.[Methods]A computer retrieval was carried out on databases,such as China National Knowledge Infrastructure(CNKI),Wan Fang and VIP,Chinese biomedicine database(CBM),Pub Med,Embase,Cochrane Library,for search of relevant clinical randomized controlled trials(RCT)involving comparison of different surgical approaches from inception to September 1 st2018.A meta-analysis was performed by using Stata 18.0 and R 3.3.3 software.[Results]A total of 2637 relevant literatures were searched,14 of them that met the including and excluding standards were finally enrolled into this study.The 14 papers involved 1011 feet that were diagnosed of Sanders type II-IV calcaneal fractures,including 501 feet surgically treated through traditional L-shaped approach,338 feet through tarsal sinus approach,89 feet through'八'-shaped approach,40 feet through transvers approach,29 feet through straight approach and 14 feet through oblique approach.In term of the postoperative complications,the tarsal sinus approach was significantly superior to the L-shaped approach(RR=0.28,95%CI:0.18~0.44),the'八'shaped was significantly superior to the L-shaped(RR=0.17,95%CI:0.04~0.75),the transvers was significantly superior to the L-shaped(RR=0.17,95%CI:0.04~0.75),and the straight was significantly superior to the L-shaped(RR=0.19,95%CI:0.06~0.58),although the oblique was equivalent to the L-shaped(RR=0.64,95%CI:0.14~3.02).According to probability sorting,the postoperative complication rates were ranked from top to bottom as follows:the oblique>traditional Lshaped>-transvers>straight>tarsal sinus>'八'shaped.[Conclusion]Although this study reveals that the'八'shaped approach has the lest risk of postoperative complication,a proper approach for calcaneal fractures should be individually selected based on the concrete condition of each patient.Due to the limitations of the patient number and quality of studies included,multicenter studies with large number of patients are need to verify this conclusion in future.