Suture anchor combined with open reduction and internal fixation versus open reduction and internal fixation for ankle fracture combined with deltoid ligament injury: a meta-analysis

doi:10.3969/j.issn.2095-4344.1069

Abstract

Abstract:

BACKGROUND: For ankle fracture combined with the deltoid ligament injury, the stability of ankle mortise is significantly affected and contact surface between tibia and astragalus is reduced, which causes local stress concentration, thus leading to the joint degeneration. Whether deltoid ligament repair is needed or not in ankle fracture combined with the triangular ligament injury still remains controversial.

OBJECTIVE: To evaluate the clinical efficacy of suture anchor combined with open reduction and internal fixation versus open reduction and internal fixation for treating ankle fracture with deltoid ligament injury.

METHODS: A computer-based retrieval of WanFang, VIP, CNKI, PubMed, EMbase, and The Cochrane Library databases was performed for the randomized controlled trials concerning suture anchor combined with open reduction and internal fixation for ankle fracture with deltoid ligament injury. The control group received no deltoid ligament repair, and the trial group underwent suture anchor combined with open reduction and internal fixation. The search period was from inception to July 2018. Data extraction and quality evaluation were performed independently by two investigators according to inclusion and exclusion criteria. Meta-analysis was conducted on RevMan 5.3 software.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

RESULTS AND CONCLUSION: (1) Nine randomized controlled trials were included involving 499 patients. (2) Meta-analysis results showed that compared with the control group, in the trial group, the total excellent rate of the Baird-Jackson ankle joint score [RR=1.27, 95%CI (1.08, 1.50), P=0.005], American Orthopaedic Foot and Ankle Society score [MD=7.81, 95%CI (5.50, 10.11), P < 0.000 01], Visual Analogue Scale score [MD=-0.15, 95%CI (-0.29, -0.01), P=0.04], tilt angle of the talus [MD=-3.92, 95%CI (-4.75, -3.09), P < 0.000 01], medial malleolus gap [MD=-0.83, 95%CI (-1.17, -0.48), P < 0.000 01], and adverse events [RR=0.26, 95%CI (0.12, 0.58), P=0.000 9] had obvious advantages (P < 0.05). (3) In summary, suture anchor combined with open reduction and internal fixation can enhance the ankle joint function, reduce the talus tilt angle as well as the width of the medial malleolus gap, restore the stability of the ankle joint, and decrease the adverse reactions, so it has a better clinical effect than the open reduction and internal fixation.

Key words: Ankle Joint, Fractures, Bone, Internal Fixators, Meta-Analysis, Tissue Engineering

CLC Number:

R459.9

Fan Zhirong, Peng Jiajie, Zhong Degui, Zhou Lin, Su Haitao, Huang Yongquan, Wu Jianglin, Liang Yihao. Suture anchor combined with open reduction and internal fixation versus open reduction and internal fixation for ankle fracture combined with deltoid ligament injury: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(8): 1307-1312.

Figures/Tables 3

2.3.4 距骨倾斜角 5篇随机对照试验报道了距骨倾斜角[4-5，8-9，12]。Meta分析结果显示，文献之间异质性较高 (P < 0.000 01，I2=97%)，采用随机效应模型分析，2组间比较差异有显著性意义[MD=-3.92，95%CI(-4.75，-3.09)，P < 0.000 01]，与对照组相比，带线锚钉联合切开复位内固定治疗可以改善术后距骨倾斜角，见图6。 2.3.5 内踝间隙 2篇随机对照试验报道了内踝间隙[8-9]。Meta分析结果显示，文献之间具有同质性(P=0.93，I2=0%)，采用固定效应模型分析，2组间比较差异有显著性意义[MD=-0.83，95%CI(-1.17，-0.48)，P < 0.000 01]，与对照组相比，带线锚钉联合切开复位内固定治疗可以有效减小术后内踝间隙宽度，见图7。 2.3.6 不良事件 4篇随机对照试验报道了不良事件[5，7，10-11]。Meta分析结果显示，文献之间具有同质性(P=0.90，I2=0%)，采用固定效应模型分析，2组间比较差异有显著性意义[RR=0.26，95%CI(0.12，0.58)，P=0.000 9]，与对照组相比，带线锚钉联合切开复位内固定术后不良反应发生率较低，见图8。 2.4 异质性和敏感度分析此次Meta分析结果显示，AOFAS评分和距骨倾斜角的异质性较高，逐个剔除单项研究后再次进行Meta分析结果显示，异质性仍然较高，各组间有统计学意义。说明此次Meta分析的结果较为可靠，异质性的来源可能与各个研究间随访时间、不同操作者的手术熟练程度不尽相同有关。 2.5 发表偏倚分析根据Cochrane手册的建议，如果使用漏斗图进行发表偏倚评价时，该指标Meta分析纳入的研究数不应少于10篇文献。否则会因为该指标纳入的研究数过少，从而导致漏斗图的检验能力下降，以致无法判断不对称性的真实性。此研究各项研究观察指标均未达到10篇文献，因而未进行发表偏倚漏斗图分析。"

References

[1] Kusnezov NA, Eisenstein ED, Diab N, et al. Medial malleolar fractures and associated deltoid ligament disruptions: current management controversies. Orthopedics. 2017;40(2):e216-e222.

[2] Halai M, Jamal B, Rea P, et al. Acute fractures of the pediatric foot and ankle. World J Pediatr. 2015;11(1):14-20.

[3] 张强,胡彬,彭亮,等. 踝部三角韧带损伤的诊疗进展[J]. 中国运动医学杂志, 2017,36(6):544-547.

[4] 张先培. 锚钉修复治疗外踝骨折合并三角韧带损伤临床研究[J]. 世界最新医学信息文摘, 2015,15(76):45-46.

[5] 林晓峰. 锚钉修复外踝骨折并三角韧带损伤的临床探讨[J]. 中外医疗, 2016,35(35):91-93.

[6] 李鹏. 踝关节损伤时手术修复三角韧带断裂的疗效分析[D]. 太原:山西医科大学, 2016.

[7] 包毅敏. 带线锚钉内固定治疗踝关节骨折合并三角韧带损伤临床研究[J]. 实用骨科杂志, 2017,23(4):371-374.

[8] 聂诗鑫. 带线锚钉联合切开复位内固定治疗踝关节骨折合并三角韧带Ⅱ、Ⅲ度损伤的疗效[J]. 贵州医药, 2017,41(4):390-391.

[9] 徐守忠. 带线锚钉联合切开复位内固定在治疗踝关节骨折合并三角韧带Ⅱ、Ⅲ度损伤的效果[J]. 双足与保健, 2017,26(15):117-138.

[10] Wu K, Lin J, Huang J, et al. Evaluation of transsyndesmotic fixation and primary deltoid ligament repair in ankle fractures with suspected combined deltoid ligament injury. J Foot Ankle Surg. 2018;57(4):694-700.

[11] 郭炜,李冠臣. 锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的效果观察[J]. 中国实用医药, 2018,13(1):51-52.

[12] 徐贤,刘林,李聪,等. 踝关节骨折合并三角韧带损伤的手术疗效分析[J]. 浙江临床医学, 2018,20(4):631-633.

[13] 伍凯,林健,黄建华,等. 急性踝关节骨折伴三角韧带损伤术中诊断及治疗策略[J]. 国际骨科学杂志,2015,36(2):141-145.

[14] 佘刚, 邹拥军, 黄靖. 锚钉修补结合切开复位内固定治疗踝关节骨折伴三角韧带损伤的疗效[J]. 安徽医学, 2017,38(10):1262-1265.

[15] 胡伟男, 崔海勇. 带线锚钉修复联合切开复位内固定治疗踝关节骨折合并三角韧带损伤[J]. 中国基层医药, 2017,24(14):2147-2151.

[16] 秦大山,徐彬,黄万强. 踝关节骨折三角韧带损伤的诊断与治疗进展[J]. 世界最新医学信息文摘, 2018,18(16):102-104.

[17] Yde J, Kristensen KD. Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. Acta Orthop Scand. 1980;51(6): 981-990.

[18] Pettrone FA, Gail M, Pee D, et al. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am. 1983;65(5):667-677.

[19] Lindsjo U. Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res. 1985;(199):28-38.

[20] Hintermann B, Knupp M, Pagenstert GI. Deltoid ligament injuries: diagnosis and management. Foot Ankle Clin. 2006;11(3):625-637.

[21] Femino JE, Vaseenon T, Phisitkul P, et al. Varus external rotation stress test for radiographic detection of deep deltoid ligament disruption with and without syndesmotic disruption: a cadaveric study. Foot Ankle Int. 2013;34(2):251-260.

[22] 何河北,董伟强,孙永建,等. 修复三角韧带与不修复对于踝关节骨折合并三角韧带损伤术效果的Meta分析[J]. 中华关节外科杂志(电子版), 2014,8(4):497-501.