螺钉与接骨板内固定治疗Lisfranc损伤疗效的Meta分析

目的：比较螺钉与接骨板内固定治疗Lisfranc损伤的临床疗效。方法：计算机检索万方、CNKI、Pubmed、EMBASE、维普、BIOSIS等数据库，检索时间为2000年1月1日至2021年8月1日的临床试验文献，严格评价纳入研究的方法学质量并提取资料，采用Revman 5.4软件对所得数据进行Meta分析。结果：纳入随机对照试验文献9篇和回顾性队列研究10篇文献，其中试验组416例患者采用螺钉内固定治疗，对照组435例患者采用接骨板内固定治疗。Meta分析显示：接骨板内固定组手术时间长于螺钉内固定组MD=-14.40，95% CI= （-17.21，-11.60），P<0.000 01]，接骨板内固定组在术后X线解剖复位情况MD=0.47，95% CI= （0.25，0.86），P=0.01]、术后美国足踝外科协会（American orthopedic foot and ankle society，AOFAS）足功能评分优良率MD=0.25，95% CI= （0.15，0.42），P<0.000 01]、术后AOFAS足功能评分MD=-5.51，95% CI= （-10.10，-0.92），P=0.02]较螺钉内固定组更优。两种手术方式在术后骨折愈合时间MD=1.91，95% CI= （-1.36，5.18），P=0.25]、术后VASMD=0.38，95% CI= （-0.09，0.86），P=0.11]、术后并发症MD=1.32，95% CI= （0.73，2.40），P=0.36]、术后感染率MD=0.84，95% CI= （0.48，1.46），P=0.53]、术后内固定失效MD=1.25，95% CI= （0.61，2.53），P=0.54]和术后创伤性关节炎发生率MD=1.80，95% CI= （0.83，3.91），P=0.14]方面比较，差异无统计学意义。结论：接骨板内固定治疗Lisfranc损伤具有更好的短期和中期结果以及更低的再手术率。所以，更推荐采用接骨板内固定治疗Lisfranc损伤。

Meta-analysis of the effect of hollow nail and bone plate on Lisfranc injury

Objective To compare the clinical efficacy of screw and bone plate internal fixation in the treatment of Lisfranc injury.Methods The databases of Wanfang, CNKI, Pubmed, EMBASE, VIP, BIOSIS and other databases were retrieved by computer, and the clinical trial literature from January 1, 2000 to August 1, 2021 was retrieved, the methodological quality of the included studies was strictly evaluated and the data were extracted, and the obtained data were meta-analyzed by Revman 5.4 software.Results Nine randomized controlled trial literature and 10 retrospective cohort studies were included, of which 416 patients in the experimental group were treated with screw internal fixation, and 435 patients in the control group were treated with bone plate internal fixation. Meta-analysis showed that the surgical time of the bone plate internal fixation group was longer than that of the screw internal fixation groupMD=-14.40, 95%CI=(-17.21, -11.60), P<0.000 01], the postoperative X-ray anatomical reduction of the bone plate internal fixation groupMD=0.47, 95%CI=(0.25, 0.86), P=0.01], the excellent and good rate of postoperative American orthopedic foot and ankle society(AOFAS) foot function scoreMD=0.25, 95%CI=(0.15, 0.42), P<0.000 01], postoperative AOFAS foot function scoreMD=-5.51, 95%CI=(-10.10, -0.92), P=0.02] of the bone plate fixation group was better than those of the screw internal fixation group. Two kinds of operation method had no statistical different for postoperative fracture healing timeMD=1.91, 95%CI=(-1.36, 5.18), P=0.25], postoperative visual analgue scale(VAS)MD=0.38, 95%CI=(0.09, 0.86), P=0.11], postoperative complicationsMD=1.32, 95%CI=(0.73, 2.40), P=0.36], the postoperative infectionMD=0.84, 95%CI=(0.48, 1.46), P=0.53], the postoperative fracture internal fixation looseningMD=1.25, 95% CI=(0.61, 2.53), P=0.54], the postoperative incidence of traumatic arthritisMD=1.80, 95%CI=(0.83, 3.91), P=0.14].Conclusion Bone plate fixation has better short-term and medium-term results and lower reoperation rate in the treatment of Lisfranc injury, so it is recommended to use bone plate fixation in the treatment of Lisfranc injury.