Abstract：
Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR=0.60, CI 0.36-1.02, p=0.06) however, EF was associated with greater odds of deep hardware infections (OR=3.67, 1.97-6.83, p <0.05) and amputations (OR=3.17, CI 1.06-9.54, p =0.04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD=31.23, CI-25.11-37.34, p <0.05) and intraoperative blood loss (MD=46.31, CI-24.93-67.69, p <0.05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes. However, IF patients are more likely to achieve primary union and less likely to have deep infections, being mindful that EF techniques were usually indicated for more complex cases. LEVEL OF EVIDENCE: IV.
摘要：
踝关节固定术是治疗终末期关节炎或严重踝关节畸形的有效手术方法。内部（IF）和外部固定（EF）技术都是有效的选择，但是关于最有效的技术存在争议。这项研究比较了EF和IF固定技术用于踝关节固定术的安全性和有效性。根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价和荟萃分析。电子数据库的文献检索，包括MEDLINE,EMBASE,和Cochrane中央控制试验登记册（CENTRAL），进行是为了识别所有直接比较这两种技术的研究。根据异质性，使用固定效应和随机效应分析模型。然而，EF和IF组的愈合几率相当(OR=0.60，CI0.36-1.02，p=0.06)，EF与深硬件感染（OR=3.67，1.97-6.83，p<0.05）和截肢（OR=3.17，CI1.06-9.54，p=0.04）的可能性更大。两组之间的翻修手术和浅表伤口并发症的几率相似。EF技术的手术时间（MD=31.23，CI-25.11-37.34，p<0.05）和术中出血量（MD=46.31，CI-24.93-67.69，p<0.05）明显更长。在疼痛和功能评分方面没有发现显著差异。IF和EF技术具有合理的愈合率，术后结果相似。然而,如果患者更有可能实现原发性愈合，并且不太可能发生深部感染，注意EF技术通常适用于更复杂的病例。证据级别：IV.
