中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (8): 1307-1312.doi: 10.3969/j.issn.2095-4344.1069

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    

切开复位内固定是否联合带线锚钉治疗踝关节骨折合并三角韧带损伤的Meta分析

范智荣1，彭嘉杰1，钟的桂1，周 霖1，苏海涛2，黄永铨2，吴江林2，梁以豪2   

  1. 1广州中医药大学第二临床医学院，广东省广州市 510405；2广州中医药大学第二附属医院骨科，广东省广州市 510006
  • 出版日期:2019-03-18 发布日期:2019-03-18
  • 通讯作者: 苏海涛，主任医师，广州中医药大学第二附属医院骨科，广东省广州市 510006
  • 作者简介:范智荣，男，1994年生，广东省怀集县人，汉族，广州中医药大学在读硕士，主要从事中医药防治骨科疾病的研究。
  • 基金资助:

    广东省中医药局科研项目(20182043)，项目负责人：黄永铨

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  

Fan Zhirong1, Peng Jiajie1, Zhong Degui1, Zhou Lin1, Su Haitao2, Huang Yongquan2, Wu Jianglin2, Liang Yihao2   

  1. 1the Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2Department of Orthopedics, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • Online:2019-03-18 Published:2019-03-18
  • Contact: Su Haitao, Chief physician, Department of Orthopedics, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • About author:Fan Zhirong, Master candidate, the Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:

    the Research Project of Traditional Chinese Medicine Bureau of Guangdong Province, No. 20182043 (to HYQ)

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摘要：

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文题释义：
踝关节骨折：踝关节损伤临床上很少为单纯踝关节骨折，常常合并周围软组织结构的损伤，有文献报道大概有40%的踝关节骨折患者会合并三角韧带的损伤。目前，临床上对于踝关节骨折合并三角韧带损伤的患者主要是以切开复位内固定治疗为主，对于是否应该修复三角韧带尚未有定论，仍然存在争议。
三角韧带的修复：临床上应用于修复三角韧带的术式较少，主要包括经骨道缝线或钢丝的传统修补术、带线锚钉修复术以及三角韧带重建术。骨道缝线和钢丝修补术因其手术伤口大，患者满意度不高而在临床较少使用；三角韧带重建术在国外研究较多而国内较少开展。随着生物材料的更新发展以及手术方式的不断进步，临床出现较多使用带线锚钉修复断裂三角韧带的报道，因具有固定牢靠、创伤较小、手术时间少等优势，其临床疗效较传统方法有明显改善。
 
摘要
背景：踝关节骨折合并三角韧带损伤时，对踝穴的稳定性造成严重的影响，减小胫距接触面，造成局部应力集中，从而导致关节退行性病变的发生。目前临床对于踝关节骨折合并三角韧带损伤是否进行三角韧带的修复尚未达到统一的结论。
目的：系统评价带线锚钉联合切开复位内固定对比切开复位内固定治疗踝关节骨折合并三角韧带损伤的临床疗效。
方法：计算机检索万方数据库、VIP数据库、CNKI、PubMed、EMbase、The Cochrane Library数据库，查找国内外公开发表的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损伤的随机对照试验，对照组不进行三角韧带的修复，仅进行切开复位内固定；试验组使用带线锚钉修复三角韧带。检索年限为各自建库至2018年7月。由2位研究者按照纳入和排除标准独立进行资料提取和质量评价，采用RevMan 5.3 版本进行Meta分析。
结果与结论：①最终纳入9个随机对照试验，共纳入499例患者；②Meta分析结果显示，与切开复位内固定组相比，带线锚钉联合切开复位内固定组在Baird-Jackson 踝关节相关评分优良率[RR=1.27，95%CI(1.08，1.50)，P=0.005]、美国足踝外科协会踝-后足评分[MD=7.81，95%CI(5.50，10.11)，P < 0.000 01]、目测类比评分[MD=-0.15，95%CI(-0.29，-0.01)，P=0.04]、距骨倾斜角[MD=-3.92，95%CI(-4.75，-3.09)，P <        0.000 01]、内踝间隙[MD=-0.83，95%CI(-1.17，-0.48)，P < 0.000 01]、不良事件发生率[RR=0.26，95%CI(0.12，0.58)，P=0.000 9]方面均有明显优势，差异有显著性意义(P < 0.05)；③Meta分析结果显示，对比单纯切开复位内固定，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损伤能够增强踝关节功能、减小距骨倾斜角及内踝间隙宽度、恢复踝关节稳定性、减少不良反应发生率，具有更好的修复效果。

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
ORCID: 0000-0002-5259-5160(范智荣)

关键词: 踝关节骨折, 三角韧带损伤, 带线锚钉, 切开复位内固定, 踝关节稳定性, 距骨倾斜角, 内踝间隙宽度, Meta分析

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

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