目的:比较螺钉与接骨板内固定治疗Lisfranc损伤的临床疗效。
方法:万方数据库,CNKI,Pubmed,EMBASE,VIP,生物多样性和其他数据库由计算机检索,并检索了2000年1月1日至2021年8月1日的临床试验文献,严格评估纳入研究的方法学质量,并提取数据,所得数据采用Revman5.4软件进行Meta分析。
结果:纳入9篇随机对照试验文献和10篇回顾性队列研究,其中实验组416例患者采用螺钉内固定治疗,对照组435例采用接骨板内固定治疗。Meta分析显示接骨板内固定组手术时间长于螺钉内固定组[MD=-14.40,95CI(-17.21,-11.60),P<0.00001],骨板内固定组术后X线解剖复位[MD=0.47,95CI(0.25,0.86),P=0.01],术后美国矫形足踝协会(AOFAS)足功能评分的优良率[MD=0.25,95CI(0.15,0.42),P<0.00001],术后AOFAS足功能评分[MD=-5.51,95CI(-10.10,-0.92),骨板固定组优于螺钉内固定组,P=0.02。两种手术方法术后骨折愈合时间差异无统计学意义[MD=1.91,95CI(-1.36,5.18),P=0.25],术后视觉分析量表(VAS)[MD=0.38,95CI(0.09,0.86),P=0.11],术后并发症[MD=1.32,95CI(0.73,2.40),P=0.36],术后感染[MD=0.84,95CI(0.48,1.46),P=0.53],术后骨折内固定松动[MD=1.25,95%CI(0.61,2.53),P=0.54],术后创伤性关节炎的发生率[MD=1.80,95CI(0.83,3.91),P=0.14]。
结论:骨板内固定治疗Lisfranc损伤的短期和中期效果较好,再手术率较低,因此,建议使用骨板固定治疗Lisfranc损伤。
OBJECTIVE: To compare the clinical efficacy of screw and bone plate internal fixation in the treatment of Lisfranc injury.
METHODS: The databases of Wanfang, CNKI, Pubmed, EMBASE, VIP, BIOSIS and other databases were retrieved by computer, and the clinical trial literature from January 1, 2000 to August 1, 2021 was retrieved, the methodological quality of the included studies was strictly evaluated and the data were extracted, and the obtained data were meta-analyzed by Revman 5.4 software.
RESULTS: Nine randomized controlled trial literature and 10 retrospective cohort studies were included, of which 416 patients in the experimental group were treated with screw internal fixation, and 435 patients in the control group were treated with bone plate internal fixation. Meta-analysis showed that the surgical time of the bone plate internal fixation group was longer than that of the screw internal fixation group [MD=-14.40, 95%CI(-17.21, -11.60), P<0.000 01], the postoperative X-ray anatomical reduction of the bone plate internal fixation group [MD=0.47, 95%CI(0.25, 0.86), P=0.01], the excellent and good rate of postoperative American orthopedic foot and ankle society(AOFAS) foot function score[MD=0.25, 95%CI(0.15, 0.42), P<0.000 01], postoperative AOFAS foot function score [MD=-5.51, 95%CI(-10.10, -0.92), P=0.02] of the bone plate fixation group was better than those of the screw internal fixation group. Two kinds of operation method had no statistical different for postoperative fracture healing time[MD=1.91, 95%CI(-1.36, 5.18), P=0.25], postoperative visual analgue scale(VAS)[MD=0.38, 95%CI(0.09, 0.86), P=0.11], postoperative complications [MD=1.32, 95%CI(0.73, 2.40), P=0.36], the postoperative infection [MD=0.84, 95%CI(0.48, 1.46), P=0.53], the postoperative fracture internal fixation loosening [MD=1.25, 95% CI(0.61, 2.53), P=0.54], the postoperative incidence of traumatic arthritis [MD=1.80, 95%CI(0.83, 3.91), P=0.14].
CONCLUSIONS: Bone plate fixation has better short-term and medium-term results and lower reoperation rate in the treatment of Lisfranc injury, so it is recommended to use bone plate fixation in the treatment of Lisfranc injury.