经跗骨窦切口与传统L形切口治疗跟骨骨折：系统评价与Meta分析  

Transtarsal sinus incision and traditional L-shaped incision for calcaneal fractures: a systematic evaluation and meta-analysis

作　　者：洪伟武 苏海涛[2] 彭嘉杰 范智荣 周俊德 黄永铨 Hong Weiwu;Su Haitao;Peng Jiajie;Fan Zhirong;Zhou Junde;Huang Yongquan(Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510000,Guangdong Province,China;Department of Orthopedics,University Town Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510006,Guangdong Province,China)

机构地区：[1]广州中医药大学第二临床医学院,广东省广州市510000 [2]广东省中医院大学城医院骨科,广东省广州市510006

出　　处：《中国组织工程研究》2020年第18期2939-2944,共6页Chinese Journal of Tissue Engineering Research

基　　金：广东省自然科学基金资助项目(2018A030313694)，项目参与人：黄永铨，苏海涛~~

摘　　要：背景:跟骨骨折约占全部跗骨骨折的60%,75%的跟骨骨折属于关节内骨折。手术治疗可更好地恢复跟骨形态与功能,近年来经跗骨窦入路开始被临床医师认知并应用,但手术治疗跟骨骨折的入路选择仍存在一定争议。目的:系统评价跟骨骨折手术治疗中经跗骨窦切口与传统L形切口2种入路的疗效以及安全性。方法:计算机检索PubMed、Cochrane、EMbase、CNKI、维普和万方数据库,查找所有比较经跗骨窦切口和传统L形切口手术治疗跟骨骨折的随机对照临床试验,检索时间从建库至2019年4月。根据纳入标准与排除标准进行文献筛选并进行数据提取后,采用RevMan 5.3软件进行Meta分析。结果与结论:①共纳入7个随机对照试验,共522例患者;②Meta分析结果显示,2种切口的末次随访的Bohler角[MD=0.14,95%CI(-0.54,0.81),P>0.05]、术后Gissane角[MD=-0.19,95%CI(-1.36,0.98),P>0.05]及Maryland评分[MD=-0.25,95%CI(-3.41,2.91),P>0.05]差异均无显著性意义;③2组末次随访美国足踝外科协会评分[MD=6.39,95%CI(-0.09,12.87),P=0.05]可能存在差异性;④与传统L形切口相比,采用经跗骨窦切口在缩短手术时间方面有着一定的优势[MD=-14.98,95%CI(-23.90,-6.06),P=0.001<0.05],术后相关并发症发生率较低[OR=0.18,95%CI(0.08,0.38),P<0.0001];⑤提示手术治疗跟骨SandersⅡ、Ⅲ型骨折,经跗骨窦切口相对于传统L形切口在疗效方面并没有明显的优势,但是由于跗骨窦切口创口较小,有着手术时间相对较短、手术后并发症发生率相对较低的优势,表明采用经跗骨窦切口安全性较高。然而,因纳入研究样本量较少,以上结论仍需更高质量、样本量更大的临床试验进行验证。BACKGROUND:Calcaneal fractures account for approximately 60%of all tarsal fractures,and 75%of calcaneal fractures are intra-articular.Surgical treatment can restore the shape and function of calcaneus well.In recent years,transtarsal sinus incision has been recognized and applied by clinicians,but the choice of surgical approach for calcaneal fractures is still controversial.OBJECTIVE:To systematically evaluate the efficacy and surgical safety of transtarsal sinus incision and traditional L-shaped incision in the treatment of calcaneal fracture.METHODS:PubMed,Cochrane,EMbase,CNKI,VIP and Wanfang databases were searched by computer for all randomized controlled trials comparing transtarsal sinus incision with traditional L-shaped incision in the treatment of calcaneal fractures.The retrieval time was from the establishment of the database to April 2019.The meta-analysis was carried out with RevMan 5.3 software after literature screening and data extraction based on inclusion criteria and exclusion criteria.RESULTS AND CONCLUSION:(1)A total of 522 patients were enrolled in 7 randomized controlled trials.(2)Meta-analysis results showed that there was no significant difference in Bohler angle[MD=0.14,95%CI(-0.54,0.81),P>0.05],Gissane angle[MD=-0.19,95%CI(-1.36,0.98),P>0.05]and Maryland score[MD=-0.25,95%CI(-3.41,2.91),P>0.05]between the two incisions at the last follow-up.(3)American Orthopaedic Foot and Ankle Society score[MD=6.39,95%CI(-0.09,12.87),P=0.05]might be different.(4)Compared with the traditional L-shaped incision,the tarsal sinus incision had certain advantages in shortening the operation time[MD=-14.98,95%CI(-23.90,-6.06),P=0.001<0.05],and lower incidence of postoperative complications[OR=0.18,95%CI(0.08,0.38),P<0.0001].(5)For Sanders II and III calcaneal fractures,the transtarsal sinus incision has no obvious advantage over the traditional L-shaped incision in terms of curative effect.However,because the transtarsal sinus incision has a relatively small wound,it has the advantages of relatively short o

关 键 词：跟骨骨折 经跗骨窦切口 传统L形切口 并发症 META分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]