背景:跟腱切开术(AT)是Ponseti铸造方法的重要方面,在80-90%的特发性马蹄足病例中进行,以纠正残余的后足马蹄。文献中描述了不同的技术,但不清楚哪种方法更优越。这篇综述旨在分析所描述的各种技术,麻醉偏好,以及AT的结果。
方法:我们搜索了PubMed,Embase,Scopus,和OvidMEDLINE用于描述在Ponseti的铸造方法中接受原发性AT的特发性马蹄内翻足病例的文章。从符合条件的研究中提取数据进行定性和定量综合。重复肌腱切开术和并发症发生率作为结果参数。
结果:19项研究纳入系统评价。在大多数情况下,使用手术刀或针头的经皮AT是足够的,并且显示出有希望的结果。局部麻醉(LA)下的门诊(OPD)和全身麻醉(GA)下的手术室(OR)的肌腱切开术与2.5%(95CI,0.4-5.4%)和0.8%(95CI,0-1.6%)的重复肌腱切开术(RT)相关。分别。OPD组和OR组之间的差别无统计学意义(p=0.875)。汇总分析显示,失败/复发率为4.2%(1.9-6.4%,p<0.001)。OPD和OR肌腱切开术的并发症发生率为1.6%(95CI,0.2-3.0%)和0.5%(95CI,0.1-0.8%)。分别,差异无统计学意义(p=0.807)。出血是最常见的并发症,在大多数情况下可以通过施加局部压力来控制。
结论:在LA下进行OPD跟腱切开术是安全且具有成本效益的,与GA下进行的成功率相似。由于目前缺乏许多比较和更高层次的证据研究,我们不能断定一种技术是否比另一种更好。
BACKGROUND: Achilles tenotomy (AT) forms an important aspect of Ponseti\'s casting method and is performed in 80-90% of idiopathic clubfoot cases to correct residual hindfoot equinus. Different techniques are described in the literature with no clarity on which method is superior. This
review aims to analyse the various techniques described, anaesthesia preferences, and outcomes of AT.
METHODS: We searched PubMed, Embase, Scopus, and Ovid MEDLINE for articles describing idiopathic clubfoot cases undergoing primary AT during Ponseti\'s casting method. Data were extracted from eligible studies for qualitative and quantitative synthesis. The repeat tenotomy and complication rates were taken as outcome parameters.
RESULTS: Nineteen studies were included for systematic
review. A percutaneous AT using a scalpel or needle is adequate in most cases and shows promising results. The out-patient department (OPD) tenotomies under local anaesthesia (LA) and operation room (OR) tenotomies under general anaesthesia (GA) were associated with a repeat tenotomy (RT) rate of 2.5% (95%CI, 0.4-5.4%) and 0.8% (95%CI, 0-1.6%), respectively. The difference between OPD and OR groups was not statistically significant (p = 0.875). The pooled analysis shows a failure/relapse rate of 4.2% (1.9-6.4%, p < 0.001) after AT. OPD and OR tenotomies were associated with a complication rate of 1.6% (95%CI, 0.2-3.0%) and 0.5% (95%CI, 0.1-0.8%), respectively, and the difference was not statistically significant (p = 0.807). Bleeding is the most common complication and is controlled in most cases by applying local pressure.
CONCLUSIONS: Performing Achilles tenotomy in OPD under LA is safe and cost-effective with similar success rates to those done under GA. With the lack of many comparative and higher-level evidence studies at present, we can\'t conclude if one technique is better than another.