手术治疗跟骨骨折并发症的Meta分析

目的 采用循证医学研究方法,评价跟骨骨折术后各种并发症的发生情况,为临床治疗策略提供依据. 方法 检索过去20年手术治疗跟骨骨折的相关文献.数据库包括Medline (1989-2008)、Cochrane Database(1989-2008)、Embase Database(1989-2008)、Science Direct (1989-2008)等.再根据具体的纳入标准,对检索出的文献及其参考文献行手工检索,对入选文献行数据汇总,采用SPSS 14.0及RevMan 5分析软件进行荟萃分析. 结果 根据预设枪索条件,共检索出1823篇关于跟骨骨折的原始文献,经过筛选和评价,最后收集到29篇临床研究报道符合本次Meta分析的纳入标准.上述研究共计2 661例患者(2 800侧忠足),提供了患者术后并发症情况及处理方法的信息.数据分析结果提示,跟骨骨折术后主要并发症包括术后感染发生率=8.6%,95%可信区间(CI)7.53～9.61]、创口边缘坏死(发生率=2.6%,95%CI 2.05～3.24)、创伤后关节炎(发生率=2.0%,95%CI 1.42～2.44)、腓骨肌腱炎(发生率=1.3%,95%C10.84～1.66)、神经血管损伤(发生率=1.2%,95%CI 0.81～1.62)、跟骨骨髓炎(发生率=1.0%,95%CI 0.60～1.33)、骨不迮(发生率=0.2%,95%CI 0.04～0.39)、骨折复位不良(发生率=0.1%)和内固定物问题(发生率=0.7%,95%CI 0.4～1.03). 结论 跟骨骨折术后并发症较常见,临床医师应正确认识并尽早予以干预,可取得较理想的疗效.

Meta-analysis of postoperative complications of calcanens fracture

Objective To evaluate development of postoperative complications of calcanens fracture by employing Evidence-based medicine method so as to provide basis for clinical treatment strategy. Methods Eligible literatures on surgical treatment of calcalneus fractures from 1989 to 2008 were retrieved through Medline, Cochrane Database, Embase Database and Science Direct. The retrieved literatures were organized and analyzed by using SPSS14.0 and RevMan5 software. Results A total of 1823 literatures on calcaneus fractures were originally obtained based on preset retrieval conditions. With screening and evaluation, 29 clinical reports involving 2 661 patients (2 800 feet) met the criteria of meta-analysis. The results of recta-analysis indicated that the incidence rates (IR) and confidence interval (CI) of the complications that included infection (IC =8.6%, 95% CI =7.53-9.61), wound-edge necrosis (IC =2.6%, 95% CI =2.05-3.24), subtalar arthritis (IC =2.0%, 95% CI = 1.42-2.44), peroneal tendinitis (IC = 1.3% , 95% CI = 0.84-1.66), vascular or nerve damage (IC = 1.2%, 95% CI 0.81-1.62), osteotitis of calcaneus (IC = 1.0% ,95% CI 0. 60-1.33), non-union (IC =0.2%, 95% CI = 0. 04-0. 39) , malreduetion (IC = 0. 1%) and painful implants (IC = 0.7% , 95% CI = 0.4-1.03) respectively. Conclusion The postoperative complications of calcaneus fracture are common clinical problems, to which professional care without delay can attain satisfactory outcome.