LARS人工韧带重建术与改良Brostrom术治疗慢性踝关节外侧不稳疗效和安全性的Meta分析  

Clinical outcomes and safety of LARS artificial ligament reconstruction versus modified Brostrom procedure for treatment of chronic lateral ankle instability:a meta-analysis

作　　者：黄龙翔 杜虎羽[2] HUANG Longxiang;DU Huyu(The Ninth Clinical Medical College of Shanxi Medical University,Taiyuan 030606,Shanxi,China;Taiyuan Central Hospital,Taiyuan 030009,Shanxi,China)

机构地区：[1]山西医科大学第九临床医学院,山西太原030606 [2]太原市中心医院,山西太原030009

出　　处：《中医正骨》2023年第9期30-36,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:系统评价韧带增强重建系统(ligament augmentation reconstruction system, LARS)人工韧带重建术和改良Brostrom术治疗慢性踝关节外侧不稳(chronic lateral ankle instability, CLAI)的疗效和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、Pubmed、Cochrane Library、Embase从数据库建库至2022年10月31日收录的比较LARS人工韧带重建术(试验组)与改良Brostrom术(对照组)治疗CLAI的有效性和安全性的随机对照试验研究文献。由2名研究者独立按照纳入和排除标准对相关文献进行筛选和数据提取,并采用Cochrane偏倚风险评估工具对纳入研究的文献进行质量评估。采用RevMan5.4软件进行Meta分析。结果:共检索到692篇文献,通过逐层筛选最终纳入7篇文献,其中英文文献5篇、中文文献2篇。Meta分析结果显示,试验组手术时间、重返运动时间均短于对照组[MD=-6.81,95%CI(-12.59,-1.03),P=0.020;MD=-5.02,95%CI(-6.40,-3.64),P=0.000],距骨前移距离小于对照组[MD=-0.42,95%CI(-0.71,-0.14),P=0.003];2组并发症发生率、足踝预后评分、足踝功能量表评分、距骨倾斜角比较,组间差异均无统计学意义[OR=0.53,95%CI(0.25,1.15),P=0.110;MD=8.55,95%CI(-1.29,18.39),P=0.090;MD=2.87,95%CI(-4.64,10.38),P=0.450;MD=-0.45,95%CI(-1.21,0.31),P=0.250]。结论:现有的证据表明,LARS人工韧带重建术治疗CLAI在踝关节功能恢复和安全性方面与改良Brostrom术相当,但前者在踝关节稳定性、手术时间、重返运动时间方面更具优势。Objective:To systematically review the clinical outcomes and safety of artificial ligament reconstruction using the ligament augmentation reconstruction system(LARS)versus modified Brostrom procedure in treatment of chronic lateral ankle instability(CLAI).Methods:All the randomized controlled trial(RCT)articles about the clinical outcomes and safety of LARS artificial ligament reconstruction(experimental group)versus modified Brostrom procedure(control group)for treatment of CLAI included from database establishing to October 31,2022 were retrieved from China National Knowledge Internet,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,Pubmed,Cochrane Library and Embase through computer.The pertinent articles were screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The methodological quality of researches in the included articles was evaluated by using Cochrane bias risk assessment tools,and then a Meta-analysis was conducted by using RevMan5.4 software.Results:Six hundred and ninety-two articles were searched out.After screening,7 articles were included in the final analysis,including 5 English articles and 2 Chinese articles.The results of Meta-analysis revealed that the operative time and time to return to preinjury activity level(RTPAL)were shorter,the anterior talar translation(ATT)was smaller in experimental group compared to control group(MD=-6.81,95%CI(-12.59,-1.03),P=0.020;MD=-5.02,95%CI(-6.40,-3.64),P=0.000;MD=-0.42,95%CI(-0.71,-0.14),P=0.003).There was no statistical difference in the postoperative complication incidence,foot and ankle outcome score(FAOS),foot and ankle ability measure(FAAM)score and talar tilt angle(TTA)between the 2 groups(OR=0.53,95%CI(0.25,1.15),P=0.110;MD=8.55,95%CI(-1.29,18.39),P=0.090;MD=2.87,95%CI(-4.64,10.38),P=0.450;MD=-0.45,95%CI(-1.21,0.31),P=0.250).Conclusion:Available evidences suggest that LARS artificial ligament reconstruction is similar to modified Brostrom procedure in

关 键 词：踝损伤 踝关节 关节不稳定性 韧带增强重建系统 改良Brostrom术 专题Meta分析 

分 类 号：R687.4[医药卫生—骨科学]