Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (3): 485-492.doi: 10.3969/j.issn.2095-4344.1950
Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury: a meta-analysis
Tian Chenyang, Chen Bin, Sun Zhengtao, Wang Xinjun, Sun Haiyu
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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Received:2019-04-24Revised:2019-04-28Accepted:2019-06-12Online:2020-01-28Published:2019-12-27 -
Contact:Sun Haiyu, Chief physician, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China -
About author:Tian Chenyang, Master candidate, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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Tian Chenyang, Chen Bin, Sun Zhengtao, Wang Xinjun, Sun Haiyu. Suture-Button fixation and screw fixation for the treatment of distal tibiofibular syndesmosis injury: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(3): 485-492.
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2.1 文献纳入情况 通过检索词共检索出中英文文献485篇，剔除重复文献237篇，根据纳入标准及阅读题目及摘要后剔除200篇，进一步阅读全文后排除摘要、病例报道、综述以及会议文献12篇，最终纳入12个文献研究[7，14-24]，见图1；其中8篇为英文文献[14-21]，4篇为中文文献[7，22-24]。共计564例患者，其中试验组(Suture-Button固定)261例患者，对照组(螺钉固定)303例患者，纳入文献的基本情况，见表1。"
2.2 纳入文献的质量评价 随机对照研究采用“Cochrane协作网的偏倚风险评估标准”对纳入的4个研究进行质量评价[14-17]，纳入研究各种偏倚所占比例见图2，纳入研究质量评价及风险评估见图3。用NOS量表评价8个队列研究如表2所示，其中2项研究得7分，3项研究得8分，3项研究得9分，表明8个队列研究都是高质量的[18-24]。"
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2.3 Meta分析结果 2.3.1 两种方式手术时间比较结果 2项研究报道了平均手术时间比较[10，24]，研究结果间不存在统计学异质性(P > 0.05，I2=29%)，采用固定效应模式分析，结果显示两种手术方式在平均手术时间比较差异无显著性意义[WMD=5.12，95%CI(-0.38，10.61)，P > 0.05]，见图4。"
2.3.2 两种方式完全负重时间比较结果 3项研究报道了完全负重时间比较[10，19，22]，研究结果间不存在统计学异质性(P > 0.05，I2=13%)，采用固定效应模式分析，结果显示两种方式完全负重时间比较差异有显著性意义[WMD=-1.50，95%CI(-2.08，-0.92)，P < 0.05]，见图5，即Suture-Button固定方式完全负重时间短。"
2.3.3 两种方式术后AOFAS评分比较结果 10项研究报道了术后AOFAS评分比较[14-16，18-24]，其中1篇文献所给数据不充分，应予以排除；4篇有术后3个月的评分，5篇有术后6个月的评分，7篇有术后12个月的评分，4篇有术后24个月的评分。 术后3个月研究结果间不存在统计学异质性(P > 0.05，I2=0%)，采用固定效应模式分析，结果显示Suture-Button固定术后3个月的AOFAS评分优于螺钉固定[WMD=6.50，95%CI(3.41，9.58)，P < 0.05]，见图6。"
术后6个月研究结果间不存在统计学异质性(P > 0.05，I2=0%)，采用固定效应模式分析，结果显示Suture-Button固定术后6个月AOFAS评分优于螺钉固定[WMD=2.87，95%CI(0.75，4.98)，P < 0.05]，见图7。 "
随访12个月研究结果间存在统计学异质性(P < 0.05，I2=53%)，采用随机效应模式分析，结果显示Suture-Button固定术后12个月AOFAS评分优于螺钉固定[WMD=2.67，95%CI(0.09，5.24)，P < 0.05]，见图8。"
术后24个月研究结果间存在统计学异质性(P < 0.05，I2=53%)，采用随机效应模式分析，结果显示Suture-Button固定术后12个月AOFAS评分优于螺钉固定[WMD=5.79，95%CI(1.41，10.18)，P < 0.05]，见图9。由此可知，Suture-Button固定术后AOFAS评分优于螺钉固定。"
通过检验评估纳入研究的发表偏倚，漏斗图结果显示发表偏倚小，见图10。"
2.3.4 两种方式术后末次随访下胫腓重叠距离比较结果 4项研究报道了末次下胫腓重叠距离比较[10，19，22，24]，采用随机效应模式分析，结果显示两种方式末次下胫腓重叠距离比较差异无显著性意义[WMD=-0.12，95%CI(-0.94，0.70)，P > 0.05]，见图11。"
2.3.5 两种方式术后末次随访下胫腓间隙比较结果 5项研究报道了下胫腓间隙比较[10，16，19，22，24]，研究结果间存在统计学异质性(P < 0.05，I2=85%)，采用随机效应模式分析，结果显示两种方式末次随访下胫腓间隙比较差异无显著性意义[WMD=-0.20，95%CI(-0.85，0.46)，P > 0.05]，见图12。 "
2.3.6 两种方式术后总并发症比较结果 10项研究报道了术后并发症的比较[10，14-18，20-21，23-24]，术后总并发症不存在统计学异质性(P > 0.05，I2=0%)，采用固定效应模式分析，结果显示两种方式术后总并发症比较差异无显著性意义[RR=0.77，95%CI(0.47，1.26)，P > 0.05]，见图13；其中伤口感染并发症不存在统计学异质性(P > 0.05，I2=0%)，采用固定效应模式分析，结果显示两种方式术后伤口感染并发症比较差异无显著性意义[RR=2.36，95%CI(0.75，7.42)，P > 0.05]，见图14；其中局部刺激不适并发症不存在统计学异质性(P > 0.05，I2=29%)，采用固定效应模式分析，结果显示两种方式术后局部刺激不适并发症比较差异无显著性意义[RR=0.95，95%CI(0.51，1.77)，P > 0.05]，见图15；其中内固定断裂并发症不存在统计学异质性(P > 0.05，I2=0%)，采用固定效应模式分析，结果显示Suture-Button固定的螺钉断裂并发症低于螺钉固定[RR=0.25，95%CI(0.08，0.76)，P < 0.05]，见图16。 "
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