距下关节制动术与外侧柱延长术治疗扁平足疗效的meta分析  

Subtalar arthroereisis stabilization versus lateral column lengthening for the treatment of flat foot:a meta-analysis

作　　者：何海洋 陈刚 艾克热木 王成伟[1] 江仁兵[1] HE Haiyang;CHEN Gang;AI Kerumu;WANG Chengwei;JIANG Renbing(Department of Bone and Soft Tissue Oncology,Third Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China;Department of Joint Surgery,Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China;Department of Foot and Ankle Surgery,Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第三附属医院骨与软组织肿瘤科,乌鲁木齐830000 [2]新疆医科大学第六附属医院关节外科,乌鲁木齐830000 [3]新疆医科大学第六附属医院足踝外科,乌鲁木齐830000

出　　处：《中华骨与关节外科杂志》2024年第3期252-260,共9页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(81860164)。

摘　　要：目的:通过meta分析比较距下关节制动术(SA)与外侧柱延长术(LCL)治疗扁平足的临床疗效。方法:检索建库至2022年8月中国知网、维普、万方、Embase、PubMed、Web of Science、The Cochrane Library数据库关于SA与LCL治疗扁平足的相关文献。由两名作者根据纳入与排除标准进行文献筛选、数据提取,并对纳入文献进行质量评价。采用Review Maager 5.4软件对术后足部正位距骨第1跖骨角(T1MT)、足部侧位距骨第1跖骨角(Meary角)、距舟覆盖角(TCA)、跟骨倾斜角(Pitch角)、疼痛视觉模拟评分(VAS)、美国足踝外科(AOFAS)踝与后足功能评分、并发症发生率进行meta分析。结果:共纳入6篇文献,其中2篇为随机对照研究,4篇为队列研究。Meta分析结果显示:SA组与LCL组在T1MT、TCA、AOFAS踝与后足功能评分、疼痛VAS评分方面比较差异均无统计学意义(P均>0.05),LCL组在矫正Pitch角结果上优于SA组(MD=-1.87,95%CI:-3.49~-0.25,P=0.02),LCL组的并发症发生率低于SA组(MD=2.17,95%CI:1.16~4.08,P=0.02)。对于<18岁的患者,SA组与LCL组在TCA、Pitch角、AOFAS踝与后足功能评分、疼痛VAS评分方面比较差异均无统计学意义(P均>0.05),LCL组在矫正Meary角结果上优于SA组(MD=-0.79,95%CI:-1.57~-0.02,P=0.04),SA组与LCL组的并发症发生率比较差异无统计学意义(MD=1.29,95%CI:0.64~2.69,P=0.50);对于≥18岁的患者,SA组的并发症发生率高于LCL组(MD=5.61,95%CI:1.49~21.13,P=0.01)。结论:LCL和SA矫正扁平足畸形均可获得满意疗效,LCL相比SA治疗扁平足畸形较严重者可以取得更好的结果。不推荐SA用于成人扁平足的治疗,因为术后并发症发生率较高,LCL的应用则无明显年龄限制。扁平足的治疗应结合患者病情制定合理化、个性化的治疗方案。Objective:This meta-analysis aimed to compare the clinical efficacy of subtalar arthroereisis(SA)and lateral column lengthening(LCL)in the treatment of flat foot.Methods:Relevant literature on the treatment of flat foot with SA and LCL was systematically retrieved from databases including CNKI,VIP,Wanfang,Embase,PubMed,Web of Science,and The Cochrane Library up to August 2022.Two reviewers independently screened the literature,extracted data,and evaluated the quality of the included studies according to predetermined exclusion and inclusion criteria.Review Manager 5.4 software was utilized to perform meta-analyses on postoperative parameters including talar 1 metatarsal angle(T1MT),Meary angle,talonavicular coverage angle(TCA),pitch angle,pain visual analogue scale(VAS),American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot scores,and complication rate.Results:A total of 6 studies were included,comprising 2 randomized controlled trials and 4 cohort studies.The meta-analysis results indicated that there was no statistically significant difference between the SA group and LCL group in terms of T1MT,TCA,AOFAS scores,and pain VAS scores(all P>0.05).Compared to the SA group,the LCL group exhibited superior correction of pitch angle(MD=-1.87,95%CI:-3.49--0.25,P=0.02)and lower complication rates(MD=2.17,95%CI:1.16-4.08,P=0.02).For patients under 18 years old,there were no statistically significant differences between the two groups in terms of TCA,pitch angle,AOFAS score,and pain VAS score(all P>0.05).However,the correction of Meary angle was significantly greater in the LCL group(MD=-0.79,95%CI:-1.57--0.02,P=0.04)than in the SA group.There was no statistically significant difference between the two groups in terms of complication rates(MD=1.29,95%CI:0.64-2.69,P=0.50).For patients aged 18 and older,the complication rate in SA group was significantly higher than that in LCL group(MD=5.61,95%CI:1.49-21.13,P=0.01).Conclusions:Both LCL and SA are effective in the treatment of flatfoot deformity,with LCL showing

关 键 词：扁平足 距下关节制动术 外侧柱延长术 

分 类 号：R681[医药卫生—骨科学]