背景:分析最近的文献,比较移位的跟骨关节内骨折(DIACF)采用切开复位内固定的可伸展外侧入路(ELA)与微创的跟骨窦入路(STA)的临床结果,重点关注伤口并发症。
方法:利用PubMed进行了全面的文献检索,EMBASE,和Cochrane图书馆数据库遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目。2013年至2022年发表的研究,证据水平(LOE)I-III,头对头比较研究报告DIACF治疗后的临床结果使用ELA和STA,包括英语全文的文学作品。数据收集包括:出版年份,研究设计,外科医生的数量,参与人数,人口统计数据(手术时的平均年龄,男性百分比,身体质量指数,医疗合并症),术前数据(损伤机制,桑德斯分类,从受伤到手术固定的时间),术中数据,以及术后临床和影像学结果(伯勒角,Gissane的角度,跟骨高度/长度/宽度)。
结果:共21篇(4项随机对照试验,17项队列研究)包括2086例跟骨骨折患者,接受ELA(n=1129)或STA(n=957)治疗符合纳入标准。与STA患者相比,ELA患者术后伤口相关并发症的风险(RR2.82,95%CI:2.00-3.98,I2=27%)和再次手术的风险(RR1.85,95%CI:0.69-5.00,I2=67%)更高。然而,ELA与术后伤口相关并发症的风险增加STA在最近的出版物中显示出下降的趋势。ELA组也经历了更长的手术时间,延长手术时间,与STA组相比,住院时间延长。最终随访时的射线照相测量,包括伯勒角,Gissane的角度,以及跟骨高度,长度,和宽度,两组间差异无统计学意义。
结论:与侵入性较小的STA相比,使用ELA手术治疗跟骨骨折的并发症和再手术率继续增加,然而,最近的文献趋势表明,这一比率正在下降。通过ELA或STA进行跟骨骨折的手术治疗均可获得可比的术后影像学结果。
方法:治疗级别III。
BACKGROUND: To analyze recent literature comparing clinical outcomes of displaced intra-articular calcaneal fractures (DIACF) treated with open reduction and internal fixation using the extensile lateral approach (ELA) vs the minimally invasive sinus tarsi approach (STA), with a focus on wound complications.
METHODS: A comprehensive literature search was conducted utilizing PubMed, EMBASE, and Cochrane Library databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 2013 and 2022, level of evidence (LOE) I-III, head-to-head comparative studies reporting on clinical outcomes after DIACFs treated with ORIF using ELA versus STA, and literature with full-text written in English were included. Data collection included: publication year, study design, number of surgeons, number of participants, demographic data (mean age at time of surgery, percent male, body mass index, medical co-morbidities), preoperative data (mechanism of injury, Sanders classification, time from injury to surgical fixation), intraoperative data, and postoperative clinical and radiographic outcomes (Böhler angle, angle of Gissane, calcaneal height/length/width).
RESULTS: A total of 21 articles (4 randomized control trials, 17 cohort studies) comprising of 2086 patients with calcaneal fractures, treated with either ELA (n = 1129) or STA (n = 957) met inclusion criteria. The risk of postoperative wound-related complications (RR 2.82, 95 % CI: 2.00-3.98, I2=27 %) and the risk of reoperation (RR 1.85, 95 % CI: 0.69-5.00, I2=67 %) was higher in ELA patients comparted to STA patients. However, the increased risk of postoperative wound-related complications with an ELA vs. STA was shown to be trending downward in recent publications. The ELA group also experienced longer time to surgery, extended operative times, and prolonged hospital stays when compared to the STA group. Radiographic measurements at final follow-up, including Böhler angle, angle of Gissane, as well as calcaneal height, length, and width, showed no statistically significant differences between the two groups.
CONCLUSIONS: Surgical treatment of calcaneal fractures utilizing the ELA continues to have an increased rate of complications and reoperation when compared to the less invasive STA, yet recent trends in the literature show that this rate is decreasing. Operative treatment of calcaneal fractures via either an ELA or STA can both achieve comparable postoperative radiographic outcomes.
METHODS: Therapeutic Level III.