经跗骨窦小切口与传统外侧L型切口内固定治疗跟骨骨折临床疗效的Meta分析  

A Meta analysis of clinical effects of internal fixation by sinus tarsi approach compared with traditional lateral L-type approach on the treatment of calcaneal fractures

作　　者：王磊[1] 马改平[1] 马延辉[1] 王凤凤[1] 曹华佗 WANG Lei;MA Gai-ping;MA Yan-hui;WANG Fengfeng;CAO Hua-tuo(Department of Trauma Repair Surgery,Affiliated Hospital of Yan 'an University,Yan 'an,Shaanxi,716000,China)

机构地区：[1]延安大学附属医院创伤修复外科,陕西716000 [2]延安市人民医院骨科,陕西716000

出　　处：《中国骨与关节杂志》2019年第7期508-516,共9页Chinese Journal of Bone and Joint

基　　金：陕西省社会发展科技攻关项目(2016SF-187)

摘　　要：目的采用Meta分析对经跗骨窦小切口手术入路(sinus tarsi approach,STA)与传统外侧L型切口手术入路(extensile L shape approach,ELA)内固定治疗跟骨骨折临床疗效的优劣进行比较。方法检索Cochrane数据库、Pubmed、SCI、Embase、中国生物医学文献数据库、维普信息数据库、万方数据库、中国期刊全文数据库,人工搜索国内外相关的骨科领域杂志,由3名独立评价员对有关文献进行数据收集,如有不同意见,通过讨论或再由第3名评价员进行复核决定。采用RevMan 5.2软件对文献的证据等级质量进行评价。计数资料,计算相对危险度或优势比;计量资料,用加权均数差或标准化均数差计算,以95%可信区间表示。评价指标包括:手术时间、手术切口长度、骨折愈合时间、软组织并发症、距下关节炎、跟腓撞击症、术后关节AOFAS评分、术中出血量、手术前后Boher角变化、手术前后Gissane角变化、住院时间等。结果本研究共纳入10个临床随机对照试验,共664例,其中STA组323例,ELA组341例,两组的手术时间相比,差异有统计学意义(SMD=2.52,95%CI:3.06~5.54,P=0.01),STA组手术时间短;STA组较ELA组的皮肤切口更小,差异有统计学意义(SMD=-6.10,95%CI:-8.86^-3.34,P<0.0001);两组的骨折愈合时间相比,差异无统计学意义(SMD=-1.29,95%CI:-2.62~0.03,P=0.05);STA组术后软组织并发症发生率较ELA组低,差异有统计学意义[OR 0.23,95%CI (0.13,0.51),P=0.0004];STA组距下关节并发症发生例数较ELA组少,且差异无统计学意义[OR 0.29,95%CI (0.14,0.59),P=0.80];两组发生跟腓撞击症的发生率相比,差异无统计学意义[OR 0.39,95%CI (0.15,1.00),P=0.99];STA组术后关节功能AOFAS评分较ELA组高,差异无统计学意义[OR 3.52,95%CI (1.88,6.60),P=0.36];STA组的术中出血较ELA组少,两组相比差异有统计学意义(SMD=-11.59,95%CI:-16.60^-6.58,P<0.00001);两组手术前后Boher角的变化相比,差异无统计学意义(SMD=0.20,95%CI:-0Objective To compare wed sinus tarsi approach with traditional lateral L-type approach in the treatment of calcaneal fractures by Cochrane Meta analysis. Methods The Cochranel Library( issue 12, 2017),Pubmed( 1966-2017.12), EMBASE( 1974-2017.12), SCI( 1979-2017.12), CBMdisc( 1979-2017.12),VIPinformation( 1989-2017.12), WAN FANG Data( 1982-2017.12), CNKI( 1966-2017.12), China and abroad orthopedic journals were searched. Randomized controlled trials of clinical effects were critically assessed by RevMan 5.2.The odds radio( OR) and relative risk( RR) were determined. All the works were expressed by 95℅ confidence intervals( CI). The time of operation, incision length, fracture healing time, wound complication, subtalarstiffiness, peroneal tendinitis, AOFAS Score, amount of operative bleeding, Boher angle change, Gissane angle change, hospital stay were evaluated. Results Ten articles were included and total of 664 patients met the evaluation criterion. The time of operation( SMD = 2.52, 95% CI: 3.06-5.54, P = 0.01), incision length( SMD =-6.10, 95% CI:-8.86--3.34, P < 0.0001),soft tissue complication [ OR 0.23, 95% CI( 0.13, 0.51), P = 0.0004 ], subtalarstiffiness [ OR 0.29, 95% CI( 0.14, 0.59),P = 0.80 ], peroneal tendinitis [ OR 0.39, 95% CI( 0.15, 1.00), P = 0.99 ], amount of bleeding [ SMD =-11.59, 95% CI:-16.60--6.58, P < 0.00001 ] and the stay time [ OR-3.40, 95% CI(-4.30,-2.50), P = 0.51 ] were reduced in the STA group [ n = 323, higher AOFAS scoring [ OR 3.52, 95% CI( 1.88, 6.60), P = 0.36 ]. There were no significant differences on Boher angle change( SMD = 0.20, 95% CI:-0.06-0.46, P = 0.13), Gissane angle changes( MD = 1.40, 95% CI:0.83-1.98, P < 0.00001) and fracture healing time( SMD =-1.29, 95% CI:-2.62-0.03, P = 0.05). Conclusions The sinus tarsi approach reduces the time of operation, incision length, soft tissue complication, subtalarstiffiness, peroneal tendinitis, amount of bleeding and hospital stay compared with traditional lateral L-type approach.

关 键 词：跟骨 骨折 骨折固定术 内 治疗结果 META分析 

分 类 号：R683.4[医药卫生—骨科学]