灵活固定与切开复位内固定术和初次关节固定术治疗韧带性 Lisfranc 损伤：系统回顾和荟萃分析。

Q2 Health Professions

Foot Pub Date : 2024-11-16 DOI:10.1016/j.foot.2024.102145

Kyle P. O’Connor , Erica R. Olfson , John T. Riehl

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引用次数: 0

摘要

简介：柔性固定术（FF）可治疗孤立的韧带性 Lisfranc 损伤，同时保留关节活动。我们假设，接受柔性固定与接受开放复位内固定术（ORIF）或初次关节固定术（PA）的患者的患者报告结果指标（PROMs）、并发症和恢复活动率相似：数据库包括 PubMed、OVID Medline、Embase、SCOPUS、Cochrane Central Register of Clinical Trials 和 clinicaltrials.gov（从开始到 2024 年 5 月 13 日）。搜索关键词主要集中在使用 FF、ORIF 或 PA 治疗 Lisfranc 损伤。仅纳入英文研究。如果Lisfranc损伤纯属韧带损伤，且有PROM评分，则纳入研究。采用 MINORS 和 GRADE 标准评估研究的质量、有效性和可比性。荟萃分析采用集合统计法。Cohen's d和几率比（OR）决定了效应大小：共纳入 25 项研究。共有184名患者接受了FF手术，236名患者接受了ORIF手术，80名患者接受了PA手术。术后，美国骨科足踝协会（AOFAS）评分分别为（89.7 ± 10.0）、（78.7 ± 44.2）和（87.4 ± 31.8），VAS疼痛评分分别为（1.5 ± 1.5）、（1.6 ± 3.8）和（0.3 ± 2.6），恢复活动率（RTA）分别为100%、63.3%和78.4%。创伤后关节炎发生率分别为0%、13.0%和0%，硬件拆除率分别为0%、86.0%和22.5%，并发症发生率分别为3.8%、17.7%和23.5%。Meta 分析表明，在更好的 AOFAS 评分和 RTA 方面，FF 比 ORIF 更有优势，创伤后关节炎、硬件移除和并发症的发生率更低（P 结论：FF 比 ORIF 更有优势：全膝关节置换术治疗 Lisfranc 损伤的效果令人满意。低质量的证据表明，前臂置换术的疗效更好，但这一结论是通过单臂研究得出的，具有很大的局限性。应进一步开展前瞻性比较研究来探讨这种关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Flexible fixation versus open reduction internal fixation and primary arthrodesis for ligamentous Lisfranc injuries: A systematic review and meta-analysis

Introduction

Flexible fixation (FF) has allowed treatment of isolated ligamentous Lisfranc injuries while preserving joint motion. We hypothesize that patient-reported outcome measures (PROMs), complications, and return-to-activity rates will be similar between patients undergoing FF versus those undergoing open reduction internal fixation (ORIF) or primary arthrodesis (PA).

Methods

Databases included PubMed, OVID Medline, Embase, SCOPUS, Cochrane Central Register of Clinical Trials, and clinicaltrials.gov from their inception to 5/13/2024. Search terms focused on treatment of Lisfranc injuries with FF, ORIF, or PA. Only English studies were included. Studies were included if the Lisfranc injury was purely ligamentous and had PROM scores. Quality, validity, and comparability were assessed using MINORS and GRADE criteria. Meta-analysis was conducted using pooled statistics. Cohen’s d and odds ratios (OR) determined effect sizes.

Results

Twenty-five studies were included. There were 184 patients undergoing FF, 236 patients undergoing ORIF, and 80 patients undergoing PA. Postoperatively, American Orthopaedic Foot and Ankle Society (AOFAS) scores were 89.7 ± 10.0, 78.7 ± 44.2, and 87.4 ± 31.8, VAS-pain scores were 1.5 ± 1.5, 1.6 ± 3.8, and 0.3 ± 2.6, and return to activity rates (RTA) were 100 %, 63.3 %, and 78.4 %, respectively. Rates of post-traumatic arthritis were 0 %, 13.0 %, and 0 %, hardware removal were 0 %, 86.0 %, and 22.5 %, and complications were 3.8 %, 17.7 %, and 23.5 %. Meta-analysis demonstrated that FF had superiority over ORIF regarding better AOFAS scores and RTA with lower rates of post-traumatic arthritis, hardware removal, and complications (p < 0.05). Also, FF had superiority over PA with higher RTA and lower rates of hardware removal and complications. PA demonstrated better VAS-pain scores (p < 0.05).

Conclusion

FF had satisfactory outcomes after Lisfranc injury treatment. Low-quality evidence suggested that FF had better outcomes, however, this conclusion was drawn from single-arm studies which have significant limitations. Further prospective, comparative studies should investigate this relationship.

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来源期刊

Foot Health Professions-Podiatry

CiteScore

2.00

自引率

0.00%

发文量

期刊介绍： The Foot is an international peer-reviewed journal covering all aspects of scientific approaches and medical and surgical treatment of the foot. The Foot aims to provide a multidisciplinary platform for all specialties involved in treating disorders of the foot. At present it is the only journal which provides this inter-disciplinary opportunity. Primary research papers cover a wide range of disorders of the foot and their treatment, including diabetes, vascular disease, neurological, dermatological and infectious conditions, sports injuries, biomechanics, bioengineering, orthoses and prostheses.