摘要
目的通过搜索关于对比切开复位内固定术与关节融合术治疗跖跗关节损伤治疗效果的文献,对两种治疗方法进行Meta分析,比较两种治疗方法的临床疗效差异,以期达到为临床治疗服务的效果。方法通过计算机检索Medline(1966.1—2015.5)、Pub Med(1980.1—2015.5)、Embase(1990.1—2015.5)、Science(1990.1—2015.5)、CNKI(1994—2015)、万方数据库(1982—2015)等数据库,同时手工检索相关文献的参考文献,收集关于比较切开复位内固定术与关节融合术治疗跖跗关节损伤的完全随机对照试验(randomized controlled trials,RCT)及临床对照试验(controlled clinical trials,CCT)的文献,通过纳入排除标准筛选,对纳入的文献进行数据提取,通过Rev Man 5.0软件进行数据分析,从而得出分析结果。结果共纳入11个对照研究,其中4个为随机对照试验。Meta分析结果显示:在术后并发症发生率及需二次手术矫形方面,两种方法不存在统计学差异。但是在术后优良率方面切开复位内固定术要优于关节融合术,在内固定物是否取出方面关节融合术优于切开复位内固定术。结论在术后优良率方面,切开复位内固定术要优于关节融合术,二次手术及术后并发症方面无明显差异,内固定物是否取出方面关节融合术要优于切开复位内固定术,所以综合考虑患者术后功能方面影响,切开复位内固定术在术后优良率方面优势明显,关节融合术在内固定取出方面具有优势,在实际操作中并不复杂,应首先考虑切开复位内固定术,关节融合术可作为二期的补救措施。
Objective To compare the therapeutic effect of primary arthrodesis and open reduction and internal fixation（ ORIF） in the treatment of Lisfranc joint injuries. Methods In Medline（ 1966. 1—2015. 5） 、Pub Med（ 1980. 1—2015. 5） 、Embase（ 1990. 1—2015. 5） 、Science（ 1990. 1—2015. 5） 、CNKI（ 1994—2015） and Wan Fang（ 1982- 2015）,the randomized controlled index about curative effect between ORIF and arthrodesis in treatment of Lisfranc joint injury were compared. Then the data were extracted and a Meta-analysis was made using Rev Man5. 0. Results A total of 11 studies,including 4 randomized controlled trials and 7 clinical controlled trials,were qualified for meta analysis. There is no significant differences in secondsurgery（ P = 0. 16 0. 05）,RR = 1. 74,95 % CI was（ 0. 81,3. 75） and the incidence of complication（ P 0. 05）,RR =1. 02,95% CI was（ 0. 67,1. 56）. Compared with ORIF,primary arthrodesis was better in removing the internal fixation（ RR =8. 57,95% CI was（ 4. 28,17. 16）,P〈 0. 0001〈 0. 05）. In the comparison of the excellent rate,ORIF was better than arthrodesis. Conclusion ORIF was better than arthrodesis in the comparison of the excellent rate. So ORIF deserve to be the primary treatment. Because of lack of RCT studies and patient member,more clinical trials with a better random design and greater number of cases are needed to improve the efficacy of evidence for such a conclusion.
出处
《实用骨科杂志》
2016年第1期21-24,73,共5页
Journal of Practical Orthopaedics
基金
河北省科技厅支撑项目(JB00 11276103D-15)
