切开复位内固定是否联合带线锚钉治疗踝关节骨折合并三角韧带损伤的Meta分析
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摘要
背景:踝关节骨折合并三角韧带损伤时,对踝穴的稳定性造成严重的影响,减小胫距接触面,造成局部应力集中,从而导致关节退行性病变的发生。目前临床对于踝关节骨折合并三角韧带损伤是否进行三角韧带的修复尚未达到统一的结论。目的:系统评价带线锚钉联合切开复位内固定对比切开复位内固定治疗踝关节骨折合并三角韧带损伤的临床疗效。方法:计算机检索万方数据库、VIP数据库、CNKI、PubMed、EMbase、The Cochrane Library数据库,查找国内外公开发表的带线锚钉联合切开复位内固定治疗踝关节骨折合并三角韧带损伤的随机对照试验,对照组不进行三角韧带的修复,仅进行切开复位内固定;试验组使用带线锚钉修复三角韧带。检索年限为各自建库至2018年7月。由2位研究者按照纳入和排除标准独立进行资料提取和质量评价,采用RevMan5.3版本进行Meta分析。结果与结论:(1)最终纳入9个随机对照试验,共纳入499例患者;(2)Meta分析结果显示,与切开复位内固定组相比,带线锚钉联合切开复位内固定组在Baird-Jackson踝关节相关评分优良率[RR=1.27,95%CI(1.08,1.50),P=0.005]、美国足踝外科协会踝-后足评分[MD=7.81,95%CI(5.50,10.11),P <0.000 01]、目测类比评分[MD=-0.15,95%CI(-0.29,-0.01),P=0.04]、距骨倾斜角[MD=-3.92,95%CI(-4.75,-3.09),P<0.000 01]、内踝间隙[MD=-0.83,95%CI(-1.17,-0.48),P <0.000 01]、不良事件发生率[RR=0.26,95%CI(0.12,0.58),P=0.000 9]方面均有明显优势,差异有显著性意义(P <0.05);(3)Meta分析结果显示,对比单纯切开复位内固定,带线锚钉联合切开复位内固定治疗踝关节骨折合并三角韧带损伤能够增强踝关节功能、减小距骨倾斜角及内踝间隙宽度、恢复踝关节稳定性、减少不良反应发生率,具有更好的修复效果。
BACKGROUND: For ankle fracture combined with the deltoid ligament injury, the stability of ankle mortise is significantly affected and contact surface between tibia and astragalus is reduced, which causes local stress concentration, thus leading to the joint degeneration. Whether deltoid ligament repair is needed or not in ankle fracture combined with the triangular ligament injury still remains controversial. OBJECTIVE: To evaluate the clinical efficacy of suture anchor combined with open reduction and internal fixation versus open reduction and internal fixation for treating ankle fracture with deltoid ligament injury.METHODS: A computer-based retrieval of WanFang, VIP, CNKI, PubMed, EMbase, and The Cochrane Library databases was performed for the randomized controlled trials concerning suture anchor combined with open reduction and internal fixation for ankle fracture with deltoid ligament injury. The control group received no deltoid ligament repair, and the trial group underwent suture anchor combined with open reduction and internal fixation. The search period was from inception to July 2018. Data extraction and quality evaluation were performed independently by two investigators according to inclusion and exclusion criteria. Meta-analysis was conducted on RevMan 5.3 software. RESULTS AND CONCLUSION:(1) Nine randomized controlled trials were included involving 499 patients.(2) Meta-analysis results showed that compared with the control group, in the trial group, the total excellent rate of the Baird-Jackson ankle joint score [RR=1.27, 95%CI(1.08, 1.50), P=0.005], American Orthopaedic Foot and Ankle Society score [MD=7.81, 95%CI(5.50, 10.11), P < 0.000 01], Visual Analogue Scale score [MD=-0.15, 95%CI(-0.29,-0.01), P=0.04], tilt angle of the talus [MD=-3.92, 95%CI(-4.75,-3.09), P < 0.000 01], medial malleolus gap [MD=-0.83, 95%CI(-1.17,-0.48), P < 0.000 01], and adverse events [RR=0.26, 95%CI(0.12, 0.58), P=0.000 9] had obvious advantages(P < 0.05).(3) In summary, suture anchor combined with open reduction and internal fixation can enhance the ankle joint function, reduce the talus tilt angle as well as the width of the medial malleolus gap, restore the stability of the ankle joint, and decrease the adverse reactions, so it has a better clinical effect than the open reduction and internal fixation.
BACKGROUND: For ankle fracture combined with the deltoid ligament injury, the stability of ankle mortise is significantly affected and contact surface between tibia and astragalus is reduced, which causes local stress concentration, thus leading to the joint degeneration. Whether deltoid ligament repair is needed or not in ankle fracture combined with the triangular ligament injury still remains controversial. OBJECTIVE: To evaluate the clinical efficacy of suture anchor combined with open reduction and internal fixation versus open reduction and internal fixation for treating ankle fracture with deltoid ligament injury.METHODS: A computer-based retrieval of WanFang, VIP, CNKI, PubMed, EMbase, and The Cochrane Library databases was performed for the randomized controlled trials concerning suture anchor combined with open reduction and internal fixation for ankle fracture with deltoid ligament injury. The control group received no deltoid ligament repair, and the trial group underwent suture anchor combined with open reduction and internal fixation. The search period was from inception to July 2018. Data extraction and quality evaluation were performed independently by two investigators according to inclusion and exclusion criteria. Meta-analysis was conducted on RevMan 5.3 software. RESULTS AND CONCLUSION:(1) Nine randomized controlled trials were included involving 499 patients.(2) Meta-analysis results showed that compared with the control group, in the trial group, the total excellent rate of the Baird-Jackson ankle joint score [RR=1.27, 95%CI(1.08, 1.50), P=0.005], American Orthopaedic Foot and Ankle Society score [MD=7.81, 95%CI(5.50, 10.11), P < 0.000 01], Visual Analogue Scale score [MD=-0.15, 95%CI(-0.29,-0.01), P=0.04], tilt angle of the talus [MD=-3.92, 95%CI(-4.75,-3.09), P < 0.000 01], medial malleolus gap [MD=-0.83, 95%CI(-1.17,-0.48), P < 0.000 01], and adverse events [RR=0.26, 95%CI(0.12, 0.58), P=0.000 9] had obvious advantages(P < 0.05).(3) In summary, suture anchor combined with open reduction and internal fixation can enhance the ankle joint function, reduce the talus tilt angle as well as the width of the medial malleolus gap, restore the stability of the ankle joint, and decrease the adverse reactions, so it has a better clinical effect than the open reduction and internal fixation.
引文
[1]Kusnezov NA, Eisenstein ED, Diab N, et al. Medial malleolar fractures and associated deltoid ligament disruptions:current management controversies. Orthopedics. 2017;40(2):e216-e222.
[2]Halai M, Jamal B, Rea P, et al. Acute fractures of the pediatric foot and ankle. World J Pediatr. 2015;11(1):14-20.
[3]张强,胡彬,彭亮,等.踝部三角韧带损伤的诊疗进展[J].中国运动医学杂志, 2017,36(6):544-547.
[4]张先培.锚钉修复治疗外踝骨折合并三角韧带损伤临床研究[J].世界最新医学信息文摘, 2015,15(76):45-46.
[5]林晓峰.锚钉修复外踝骨折并三角韧带损伤的临床探讨[J].中外医疗, 2016,35(35):91-93.
[6]李鹏.踝关节损伤时手术修复三角韧带断裂的疗效分析[D].太原:山西医科大学, 2016.
[7]包毅敏.带线锚钉内固定治疗踝关节骨折合并三角韧带损伤临床研究[J].实用骨科杂志, 2017,23(4):371-374.
[8]聂诗鑫.带线锚钉联合切开复位内固定治疗踝关节骨折合并三角韧带Ⅱ、Ⅲ度损伤的疗效[J].贵州医药, 2017,41(4):390-391.
[9]徐守忠.带线锚钉联合切开复位内固定在治疗踝关节骨折合并三角韧带Ⅱ、Ⅲ度损伤的效果[J].双足与保健, 2017,26(15):117-138.
[10]Wu K, Lin J, Huang J, et al. Evaluation of transsyndesmotic fixation and primary deltoid ligament repair in ankle fractures with suspected combined deltoid ligament injury. J Foot Ankle Surg.2018;57(4):694-700.
[11]郭炜,李冠臣.锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的效果观察[J].中国实用医药, 2018,13(1):51-52.
[12]徐贤,刘林,李聪,等.踝关节骨折合并三角韧带损伤的手术疗效分析[J].浙江临床医学, 2018,20(4):631-633.
[13]伍凯,林健,黄建华,等.急性踝关节骨折伴三角韧带损伤术中诊断及治疗策略[J].国际骨科学杂志,2015,36(2):141-145.
[14]佘刚,邹拥军,黄靖.锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的疗效[J].安徽医学, 2017,38(10):1262-1265.
[15]胡伟男,崔海勇.带线锚钉修复联合切开复位内固定治疗踝关节骨折合并三角韧带损伤[J].中国基层医药, 2017,24(14):2147-2151.
[16]秦大山,徐彬,黄万强.踝关节骨折三角韧带损伤的诊断与治疗进展[J].世界最新医学信息文摘, 2018,18(16):102-104.
[17]Yde J, Kristensen KD. Ankle fractures:supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. Acta Orthop Scand. 1980;51(6):981-990.
[18]Pettrone FA, Gail M, Pee D, et al. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am. 1983;65(5):667-677.
[19]Lindsjo U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res. 1985;(199):28-38.
[20]Hintermann B, Knupp M, Pagenstert GI. Deltoid ligament injuries:diagnosis and management. Foot Ankle Clin. 2006;11(3):625-637.
[21]Femino JE, Vaseenon T, Phisitkul P, et al. Varus external rotation stress test for radiographic detection of deep deltoid ligament disruption with and without syndesmotic disruption:a cadaveric study. Foot Ankle Int. 2013;34(2):251-260.
[22]何河北,董伟强,孙永建,等.修复三角韧带与不修复对于踝关节骨折合并三角韧带损伤术效果的Meta分析[J].中华关节外科杂志(电子版), 2014,8(4):497-501.
[2]Halai M, Jamal B, Rea P, et al. Acute fractures of the pediatric foot and ankle. World J Pediatr. 2015;11(1):14-20.
[3]张强,胡彬,彭亮,等.踝部三角韧带损伤的诊疗进展[J].中国运动医学杂志, 2017,36(6):544-547.
[4]张先培.锚钉修复治疗外踝骨折合并三角韧带损伤临床研究[J].世界最新医学信息文摘, 2015,15(76):45-46.
[5]林晓峰.锚钉修复外踝骨折并三角韧带损伤的临床探讨[J].中外医疗, 2016,35(35):91-93.
[6]李鹏.踝关节损伤时手术修复三角韧带断裂的疗效分析[D].太原:山西医科大学, 2016.
[7]包毅敏.带线锚钉内固定治疗踝关节骨折合并三角韧带损伤临床研究[J].实用骨科杂志, 2017,23(4):371-374.
[8]聂诗鑫.带线锚钉联合切开复位内固定治疗踝关节骨折合并三角韧带Ⅱ、Ⅲ度损伤的疗效[J].贵州医药, 2017,41(4):390-391.
[9]徐守忠.带线锚钉联合切开复位内固定在治疗踝关节骨折合并三角韧带Ⅱ、Ⅲ度损伤的效果[J].双足与保健, 2017,26(15):117-138.
[10]Wu K, Lin J, Huang J, et al. Evaluation of transsyndesmotic fixation and primary deltoid ligament repair in ankle fractures with suspected combined deltoid ligament injury. J Foot Ankle Surg.2018;57(4):694-700.
[11]郭炜,李冠臣.锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的效果观察[J].中国实用医药, 2018,13(1):51-52.
[12]徐贤,刘林,李聪,等.踝关节骨折合并三角韧带损伤的手术疗效分析[J].浙江临床医学, 2018,20(4):631-633.
[13]伍凯,林健,黄建华,等.急性踝关节骨折伴三角韧带损伤术中诊断及治疗策略[J].国际骨科学杂志,2015,36(2):141-145.
[14]佘刚,邹拥军,黄靖.锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的疗效[J].安徽医学, 2017,38(10):1262-1265.
[15]胡伟男,崔海勇.带线锚钉修复联合切开复位内固定治疗踝关节骨折合并三角韧带损伤[J].中国基层医药, 2017,24(14):2147-2151.
[16]秦大山,徐彬,黄万强.踝关节骨折三角韧带损伤的诊断与治疗进展[J].世界最新医学信息文摘, 2018,18(16):102-104.
[17]Yde J, Kristensen KD. Ankle fractures:supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. Acta Orthop Scand. 1980;51(6):981-990.
[18]Pettrone FA, Gail M, Pee D, et al. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am. 1983;65(5):667-677.
[19]Lindsjo U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res. 1985;(199):28-38.
[20]Hintermann B, Knupp M, Pagenstert GI. Deltoid ligament injuries:diagnosis and management. Foot Ankle Clin. 2006;11(3):625-637.
[21]Femino JE, Vaseenon T, Phisitkul P, et al. Varus external rotation stress test for radiographic detection of deep deltoid ligament disruption with and without syndesmotic disruption:a cadaveric study. Foot Ankle Int. 2013;34(2):251-260.
[22]何河北,董伟强,孙永建,等.修复三角韧带与不修复对于踝关节骨折合并三角韧带损伤术效果的Meta分析[J].中华关节外科杂志(电子版), 2014,8(4):497-501.