两种手术方式治疗SandersⅡ与Ⅲ型跟骨骨折疗效的Meta分析  

A Meta-analysis of two surgical methods for Sanders typeⅡand typeⅢcalcaneal fractures

作　　者：刘泽民[1] 吕欣[1] 张经 许晓沛 张超[1] 郭华楠 LIU Ze-min;LYV Xin;ZHANG Jing;XU Xiao-Pei;ZHANG Chao;GUO Hua-nan(Department of Orthopedics,The Second Hospital of Shanxi Medical University,Taiyuan,Shanxi,030001,China)

机构地区：[1]山西医科大学第二医院骨创科,太原030001

出　　处：《中国骨与关节杂志》2021年第5期391-400,共10页Chinese Journal of Bone and Joint

摘　　要：目的通过Meta分析比较闭合复位与切开复位治疗SandersⅡ、Ⅲ型跟骨骨折的疗效差异。方法通过检索Cochrane、PubMed、Embase、万方、中国知网、维普数据库,收集2010年1月至2020年3月发表的关于切开复位钢板内固定与闭合复位空心钉内固定治疗SandersⅡ、Ⅲ型跟骨骨折的随机或非随机对照研究,严格评价纳入研究的文献质量,提取数据并进行核对,运用RevMan 5.3软件对数据进行Meta分析。结果共纳入15个研究,共1235例(1256足),其中闭合组619例(630足),切开组616例(620足)。Meta分析结果显示:闭合组住院时间短于切开组[MD=-11.57,95%CI(-12.18,-10.96),P<0.05];闭合组术后总并发症少于切开组[OR=0.21,95%CI(0.14,0.31),P<0.05],其中切口感染并发症闭合组也少于切开组[OR=0.25,95%CI(0.13,0.48),P<0.05]。闭合组和切开组在术后创伤性关节炎的发生[OR=0.48,95%CI(0.17,1.29),P>0.05]、骨折愈合时间[MD=-1.38,95%CI(-4.53,1.78),P>0.05]及术后Bohler角[MD=-0.07,95%CI(-0.33,0.18),P>0.05]方面相比,差异均无统计学意义;闭合组术后跟骨宽度大于切开组[MD=0.75,95%CI(0.58,0.93),P<0.05],末次随访AOFAS评分高于切开组[MD=1.14,95%CI(0.87,1.42),P<0.05]。结论闭合复位空心钉内固定术治疗SandersⅡ、Ⅲ型跟骨骨折的疗效优于切开复位钢板内固定术,可减少术后切口并发症的发生,提高踝关节功能。Objective To compare closed reduction and open reduction in the treatment of SandersⅡ,Ⅲcalcaneal fractures.Methods PubMed,Embase,the Cochrane library,Wanfang,CNKI and VIP database were retrieved from January 2010 to March 2020 to collect randomized or non-randomized controlled studies on closed reduction and open reduction in the treatment of SandersⅡ,Ⅲcalcaneal fractures.Strict evaluation of research literature was conducted.RevMan 5.3 software was used for Meta analysis.Results A total of 15 studies were included with 1256 feet of 1235 cases,including 630 feet of 619 cases in the closed group and 620 feet of 616 cases in the open reduction group.Meta analysis results:hospital stay of the closed group was shorter than that of the open group[MD=-11.57,95% CI(-12.18,-10.96),P<0.05];less postoperative complications of the closed group[OR=0.21,95% CI(0.14,0.31),P<0.05];less infection-related complications of the closed group[OR=0.25,95% CI(0.13,0.48),P<0.05];wider calcaneus of the closed group[MD=0.75,95%CI(0.58,0.93),P<0.05];higher AOFAS of the closed group[MD=1.14,95% CI(0.87,1.42),P<0.05];no statistically significant differences in postoperative traumatic arthritis[OR=0.48,95% CI(0.17,1.29),P>0.05],fracture healing time[MD=-1.38,95% CI(-4.53,1.78),P>0.05]and postoperative Bohler Angle[MD=-0.07,95% CI(-0.33,0.18),P>0.05]were observed between the two groups.Conclusions Closed reduction and cannulated screw fixation are superior to open reduction and plate fixation in the treatment of SandersⅡ,Ⅲcalcaneal fractures with less postoperative complications and better ankle functions.

关 键 词：跟骨骨折 闭合复位空心钉内固定 切开复位钢板内固定 META分析 

分 类 号：R683.4[医药卫生—骨科学]