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

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Pub Med、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Rev Man 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),P0.00 001],术后并发症发生率低OR=0.10,95%CI(0.05,0.21),P0.00 001];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),P0.00 001]。传统外侧L形入路术后B?hler角优于跗骨窦入路MD=-0.80,95%CI(-1.45,-0.14),P0.05]。而两种切口入路在术后Gissane角MD=0.35,95%CI(-0.77,1.47),P0.05]及Maryland足部功能评分MD=2.12,95%CI(-0.71,4.95),P0.05]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。

Minimally invasive sinus tarsal approach versus conventional L-shaped lateral approach in treating calcaneal fractures: a Meta-analysis

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 timeMD=-5.41,95%CI(-6.71,-4.12),P<0.000 01],lower incidence of postoperative complicationsOR=0.10,95%CI(0.05,0.21),P<0.000 01],and higher AOFAS scoreMD=-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 approachMD=-0.80,95%CI(-1.45,-0.14),P<0.05]. While there were no significant differences in postoperative Gissanes angleMD=0.35,95%CI(-0.77,1.47),P>0.05] and Maryland scoreMD=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.