踝关节融合术与全踝关节置换术治疗终末期踝关节炎临床疗效的Meta分析

目的:系统评价全踝关节置换术(total ankle arthroplasty,TAA)和踝关节融合术(ankle arthrodesis,AA)在治疗终末期踝关节炎的临床疗效。方法:文献检索PubMed、EMBASE和Cochrane图书馆数据库发表的TAA或AA治疗终末期踝关节炎的文献,检索日期从建库至2021年6月。采用偏倚风险工具进行文献质量评价。采用RevMan 5.3软件美国足对两组踝外科协会踝与后足评分(American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale,AOFAS)、视觉模拟评分(visual analog scale,VAS)、踝关节骨关节炎评分(ankle osteoarthritis scale,AOS),步态分析(步速、步频、步幅)、活动范围(range of motion,ROM),满意度、并发症和再次手术率进行Meta分析。结果:共纳入12篇文献,其中AA组1 050例,TAA组3 760例,共计4 810例患者。Meta分析结果显示两组的AOFAS总分MD=-3.12,95%C...

Meta-analysis of clinical efficacy of ankle arthrodesis and total ankle arthroplasty in the treatment of end-stage ankle arthritis

Objective To systematically review the clinical efficacy of total ankle arthroplasty (TAA) and ankle arthrodesis (AA) in the treatment of end-stage ankle arthritis. Methods The PubMed,EMBASE and Cochrane Library databases were searched for articles published in the treatment of end-stage ankle arthritis with AA or TAA from the establishment of the database to June 2021. Bias risk tool was used to evaluate the quality of the literature. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS),visual analog scale (VAS),ankle osteoarthritis scale(AOS),gait analysis (pace,frequency,stride),range of motion (ROM),satisfaction,complications and reoperation rate were analyzed by meta-analysis between AA and TAA groups by RevMan 5.3 software. Results A total of 12 articles were included,including 1 050 patients in the AA group and 3 760 patients in the TAA group,totaling 4 810 patients. Meta-analysis showed that the total score of AOFASMD=-3.12,95%CI(-9.02,2.96),P=0.31],pain scoreMD=1.60,95%CI(-1.35,4.54),P=0.29],alignmentl scoreMD=-0.04,95%CI(-0.52,0.44),P=0.88],VASMD=0.10,95%CI(-0.49,0.68),P=0.74],and AOS total scoreMD=-4.01,95%CI(-8.28,0.25),P=0.06],the difference was not statistically significant (P>0.05). The score of AOFAS functional in TAA group was significantly higher than that in TAA groupMD=44.22,95%CI(-8.01,-0.43),P=0.03]. There was no significant difference in gait analysis between the two groups (P>0.05). Postoperative ROMMD=-4.93,95%CI(-6.35,-3.52),P<0.000 01] and change in ROM from preoperative to follow-upMD=-5.74,95%CI(-8.88,-2.61),P=0.0003] between two groups,the difference was statistically significant. There was no significant difference in satisfaction between the two groupsOR=1.011,95%CI(0.46,2.23),P=0.98]. ComplicationsOR=1.61,95%CI(1.26,2.06),P=0.0002] and non-revision reoperationOR=1.61,95%CI(1.17,2.21),P=0.003] were significantly lower in the TAA group than in the AA group. There was no significant difference in the rate of revision and reoperation(P>0.05) between the two groupsOR=1.02,95%CI(0.37,2.78),P=0.97]. Conclusion The clinical efficacy of AA is similar to that of TAA,but the non revision reoperation rate and main surgical complications of TAA are significantly reduced. Therefore,further high-quality methodological research and long-term follow-up are needed to confirm this conclusion.