PDF(Pubmed)
Abstract：
OBJECTIVE: This study aimed to compare the efficacy and safety of the intramedullary nail and conventional plate for the treatment of displaced intra-articular calcaneal fractures from clinical comparative trials.
METHODS: A comprehensive search of English databases was carried out in the Springer, PubMed, ScienceDirect, Web of Science, and Cochrane Library databases until September 2023. Studies on calcaneal fractures treated by an intramedullary nail or a plate were considered for inclusion. Endpoints included duration of operation, length of hospital stay, the Visual Analog Scale (VAS) score, postoperative functional score, radiological parameters, and complications. The mean difference (MD) and risk difference (RD) as the combined variables, as well as the 95% confidence intervals, (CIs) were calculated.
RESULTS: Five retrospective controlled studies covering 473 feet at the one-year follow-up met the inclusion criteria. The meta-analysis demonstrated that there were significant differences in the duration of operation (MD: -10.81; 95% CI: -16.32, -5.31; p=0.0001), length of hospital stay (MD: -3.65; 95% CI: -4.35, -2.95; p<0.00001). No significant differences were found regarding postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (MD: 0.36; 95% CI: -3.89, 4.61; p=0.87), VAS (MD: 1.95; 95% CI: -0.30, 4.21; p=0.09), or postoperative Böhler angle (MD: 0.94; 95% CI: -0.04, 1.92; p=0.06) between the two groups. The incidence of total complications (RD: -0.31; 95% CI: -0.46, -0.17; p<0.0001) and wound-healing complications (RD: -0.16; 95% CI: -0.30, -0.03; p=0.02) were lower in the intramedullary nail group. There were no significant differences in the incidences of revision surgery, implant removal, superficial wound infection, deep infection, and nonunion.
CONCLUSIONS: Compared to conventional plates, the intramedullary nail showed a shorter duration of operation, reduced length of hospital stay, and fewer postoperative total complications and wound-healing complications in treating displaced intra-articular calcaneal fractures.
METHODS: A comprehensive search of English databases was carried out in the Springer, PubMed, ScienceDirect, Web of Science, and Cochrane Library databases until September 2023. Studies on calcaneal fractures treated by an intramedullary nail or a plate were considered for inclusion. Endpoints included duration of operation, length of hospital stay, the Visual Analog Scale (VAS) score, postoperative functional score, radiological parameters, and complications. The mean difference (MD) and risk difference (RD) as the combined variables, as well as the 95% confidence intervals, (CIs) were calculated.
RESULTS: Five retrospective controlled studies covering 473 feet at the one-year follow-up met the inclusion criteria. The meta-analysis demonstrated that there were significant differences in the duration of operation (MD: -10.81; 95% CI: -16.32, -5.31; p=0.0001), length of hospital stay (MD: -3.65; 95% CI: -4.35, -2.95; p<0.00001). No significant differences were found regarding postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (MD: 0.36; 95% CI: -3.89, 4.61; p=0.87), VAS (MD: 1.95; 95% CI: -0.30, 4.21; p=0.09), or postoperative Böhler angle (MD: 0.94; 95% CI: -0.04, 1.92; p=0.06) between the two groups. The incidence of total complications (RD: -0.31; 95% CI: -0.46, -0.17; p<0.0001) and wound-healing complications (RD: -0.16; 95% CI: -0.30, -0.03; p=0.02) were lower in the intramedullary nail group. There were no significant differences in the incidences of revision surgery, implant removal, superficial wound infection, deep infection, and nonunion.
CONCLUSIONS: Compared to conventional plates, the intramedullary nail showed a shorter duration of operation, reduced length of hospital stay, and fewer postoperative total complications and wound-healing complications in treating displaced intra-articular calcaneal fractures.
摘要：
目的：本研究旨在从临床对比试验中比较髓内钉和常规钢板治疗移位的跟骨关节内骨折的疗效和安全性。
方法：在Springer对英文数据库进行了全面搜索，PubMed,ScienceDirect,WebofScience,和Cochrane图书馆数据库，直到2023年9月。考虑纳入髓内钉或钢板治疗跟骨骨折的研究。终点包括操作持续时间，住院时间,视觉模拟量表(VAS)评分，术后功能评分,放射学参数，和并发症。以平均差(MD)和风险差(RD)为组合变量，以及95%的置信区间，（CI）进行了计算。
结果：在一年的随访中，覆盖473英尺的五项回顾性对照研究符合纳入标准。荟萃分析表明，手术时间存在显着差异（MD：-10.81;95％CI：-16.32，-5.31;p=0.0001），住院时间（MD：-3.65；95%CI：-4.35，-2.95；p<0.00001）。关于术后美国骨科足踝协会（AOFAS）踝足-后足评分（MD：0.36；95％CI：-3.89，4.61；p=0.87），VAS（MD：1.95；95%CI：-0.30，4.21；p=0.09），或术后Böhler角(MD:0.94;95%CI:-0.04,1.92;p=0.06)。髓内钉组的总并发症（RD：-0.31；95％CI：-0.46，-0.17；p<0.0001）和伤口愈合并发症（RD：-0.16；95％CI：-0.30，-0.03；p=0.02）的发生率较低。翻修手术的发生率没有显着差异，移除植入物,浅表伤口感染,深部感染,和不工会。
结论：与常规板相比，髓内钉显示手术时间较短，缩短住院时间,治疗移位的跟骨关节内骨折的术后总并发症和伤口愈合并发症较少。
方法：在Springer对英文数据库进行了全面搜索，PubMed,ScienceDirect,WebofScience,和Cochrane图书馆数据库，直到2023年9月。考虑纳入髓内钉或钢板治疗跟骨骨折的研究。终点包括操作持续时间，住院时间,视觉模拟量表(VAS)评分，术后功能评分,放射学参数，和并发症。以平均差(MD)和风险差(RD)为组合变量，以及95%的置信区间，（CI）进行了计算。
结果：在一年的随访中，覆盖473英尺的五项回顾性对照研究符合纳入标准。荟萃分析表明，手术时间存在显着差异（MD：-10.81;95％CI：-16.32，-5.31;p=0.0001），住院时间（MD：-3.65；95%CI：-4.35，-2.95；p<0.00001）。关于术后美国骨科足踝协会（AOFAS）踝足-后足评分（MD：0.36；95％CI：-3.89，4.61；p=0.87），VAS（MD：1.95；95%CI：-0.30，4.21；p=0.09），或术后Böhler角(MD:0.94;95%CI:-0.04,1.92;p=0.06)。髓内钉组的总并发症（RD：-0.31；95％CI：-0.46，-0.17；p<0.0001）和伤口愈合并发症（RD：-0.16；95％CI：-0.30，-0.03；p=0.02）的发生率较低。翻修手术的发生率没有显着差异，移除植入物,浅表伤口感染,深部感染,和不工会。
结论：与常规板相比，髓内钉显示手术时间较短，缩短住院时间,治疗移位的跟骨关节内骨折的术后总并发症和伤口愈合并发症较少。
