经微创跗骨窦切口入路与传统外侧L形切口入路比较治疗跟骨骨折的Meta分析
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作者Author单位AddressE-Mail
吴旻昊 WU Min-hao 武汉大学中南医院骨四科, 湖北 武汉 430071 The 4th Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China  
孙文超 SUN Wen-chao 武汉大学中南医院骨四科, 湖北 武汉 430071 The 4th Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China  
闫飞飞 YAN Fei-fei 武汉大学中南医院骨四科, 湖北 武汉 430071 The 4th Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China  
侯志强 HOU Zhi-qiang 武汉大学中南医院骨四科, 湖北 武汉 430071 The 4th Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China  
冯帆 FENG Fan 武汉大学中南医院骨四科, 湖北 武汉 430071 The 4th Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China  
蔡林 CAI Lin 武汉大学中南医院骨四科, 湖北 武汉 430071 The 4th Department of Orthopaedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China orthopedics@whu.edu.cn 
期刊信息:《中国骨伤》2017年,第30卷,第12期,第1118-1126页
DOI:10.3969/j.issn.1003-0034.2017.12.009
基金项目:
中文摘要:

目的:比较微创跗骨窦切口入路(minimally invasive sinus tarsal appproach,MISTA)与传统外侧L形切口入路(conventional L-shaped lateral approach,CLSLA)两种术式治疗跟骨骨折的安全性和疗效。

方法:计算机检索PubMed、CENTRAL、EMbase、ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有比较MISTA和CLSLA治疗跟骨骨折的随机或非随机对照试验(RCT or NOT RCT),检索时限均为建库至2017年3月。按纳入排除标准由2人独立进行RCT或非RCT的筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析,并采用GRADE系统进行证据质量评价。

结果:共纳入4个随机对照试验和4个非随机对照试验,共493例患者。Meta分析结果显示:与传统外侧L形入路相比,跗骨窦入路的手术时间较短[MD=-5.41,95% CI(-6.71,-4.12),P<0.00 001],术后并发症发生率低[OR=0.10,95% CI(0.05,0.21),P<0.00 001];末次随访时AOFAS评分优于传统外侧L形切口入路[MD=3.09,95% CI(1.72,4.46),P<0.00 001]。传统外侧L形入路术后Böhler角优于跗骨窦入路[MD=-0.80,95% CI(-1.45,-0.14),P<0.05]。而两种切口入路在术后Gissane角[MD=0.35,95% CI(-0.77,1.47),P>0.05]及Maryland足部功能评分[MD=2.12,95% CI(-0.71,4.95),P>0.05]方面比较差异无统计学意义。

结论:微创跗骨窦入路与传统外侧L形入路在跟骨骨折的治疗上疗效相当,但跗骨窦入路具有手术时间短,术后并发症发生率低,安全性更高的优势。由于原始研究的样本量较少,建议临床上根据患者的实际情况谨慎选择手术入路。
【关键词】跟骨  骨折  Meta分析
 
Minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures: a Meta-analysis
ABSTRACT  

Objective: To compare efficacy and safety of minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures.

Methods: The studies concerning about randomized controlled trial and non-randomized controlled trial of minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures from the time of creating database to March,2017 were searched from PubMed,Cochrane Central Register of Controlled Trials (CENTRAL),EMbase,ISI Web of Knowledge databases,VIP,CNKI,CBM and Wan Fang. The literatures which screened by randomized controlled trial and non-randomized controlled trial were extracted and performed quality assessment by two people. Meta analysis were performed by RevMan 5.3 software and GRADE system were used to evaluate quality.

Results: Four randomized controlled trial and 4 non-randomized controlled trial were included,totally 493 patients. Meta-analysis results showed compared with conventional L-shaped lateral approach,minimally invasive sinus tarsal approach had shorter operative time[MD=-5.41,95%CI(-6.71,-4.12),P<0.000 01],lower incidence of postoperative complications[OR=0.10,95%CI(0.05,0.21),P<0.000 01],and higher AOFAS score[MD=-3.09,95%CI(-1.72,4.46),P<0.000 01] at the final follow-up. Böhler angle in conventional L-shaped lateral approach was better than that of minimally invasive sinus tarsal approach[MD=-0.80,95%CI(-1.45,-0.14),P<0.05]. While there were no significant differences in postoperative Gissanes angle[MD=0.35,95%CI(-0.77,1.47),P>0.05] and Maryland score[MD=2.12,95%CI(-0.71,4.95),P>0.05] between two groups.

Conclusion: Minimally invasive sinus tarsal approach and conventional L-shaped lateral approach has similar clinical effect for the treatment of calcaneal fractures. However,minimally invasive sinus tarsal approach has advantages of shorter operation time,lower incidence of complication and better safety. For the limited quantity of the original studies,operative approach should be chosen according to the patient.
KEY WORDS  Calcaneus  Fractures  Meta-analysis
 
引用本文,请按以下格式著录参考文献:
中文格式:吴旻昊,孙文超,闫飞飞,侯志强,冯帆,蔡林.经微创跗骨窦切口入路与传统外侧L形切口入路比较治疗跟骨骨折的Meta分析[J].中国骨伤,2017,30(12):1118~1126
英文格式:WU Min-hao,SUN Wen-chao,YAN Fei-fei,HOU Zhi-qiang,FENG Fan,CAI Lin.Minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures: a Meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(12):1118~1126
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