Zwiers Ruben, Wiegerinck Johannes I, Murawski Christopher D, Fraser Ethan J, Kennedy John G, van Dijk C Niek
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Hospital for Special Surgery, New York, New York, U.S.A.
Arthroscopy. 2015 Aug;31(8):1585-96. doi: 10.1016/j.arthro.2015.01.023. Epub 2015 Mar 19.
To provide a comprehensive overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement.
A systematic literature search of the Medline, Embase (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases was performed. Studies that met the following inclusion criteria were reviewed: studies reporting outcomes of arthroscopic treatment for anterior ankle impingement; studies reporting on more than 20 patients; a study population with a minimum age of 18 years; and studies in the English, Dutch, German, Italian, or Spanish language. Two reviewers independently performed data extraction. Extracted data consisted of population characteristics, in addition to both primary and secondary outcome measures. The Downs and Black scale was used to assess the methodologic quality of randomized and nonrandomized studies included in this review.
Twenty articles were included in this systematic review. Overall, good results were found for arthroscopic treatment in patients with anterior ankle impingement. In the studies that reported patient satisfaction rates, high percentages of good to excellent satisfaction were described (74% to 100%). The percentages of patients who would undergo the same procedure again under the same circumstances were also high (94.3% to 97.5%). Complication rates were low (4.6%), particularly with respect to major complications (1.1%). The high heterogeneity of the included studies made it impossible to compare the results of the studies, including between anterolateral impingement and anteromedial impingement.
Arthroscopic treatment for anterior ankle impingement appears to provide good outcomes with respect to patient satisfaction and low complication rates. However, on the basis of the findings of this study, no conclusion can be made in terms of the effect of the type of impingement or additional pathology on clinical outcome.
Level IV, systematic review of Level II and IV studies.
全面概述关节镜手术作为治疗前踝撞击症的一种治疗策略的临床疗效。
对Medline、Embase（经典版）和CINAHL（护理学与健康相关文献累积索引）数据库进行系统的文献检索。对符合以下纳入标准的研究进行综述：报告关节镜治疗前踝撞击症疗效的研究；报告患者超过20例的研究；研究人群的最低年龄为18岁；以及英文、荷兰文、德文、意大利文或西班牙文的研究。两名审阅者独立进行数据提取。提取的数据除了主要和次要结局指标外，还包括人群特征。采用唐斯和布莱克量表评估本综述中纳入的随机和非随机研究的方法学质量。
本系统综述纳入了20篇文章。总体而言，关节镜治疗前踝撞击症患者取得了良好的效果。在报告患者满意率的研究中，描述了高比例的良好至优秀满意率（74%至100%）。在相同情况下愿意再次接受相同手术的患者比例也很高（94.3%至97.5%）。并发症发生率较低（4.6%），尤其是严重并发症（1.1%）。纳入研究的高度异质性使得无法比较各研究结果，包括前外侧撞击症和前内侧撞击症之间的结果。
关节镜治疗前踝撞击症在患者满意度和低并发症发生率方面似乎提供了良好的疗效。然而，根据本研究结果，无法就撞击类型或其他病理情况对临床结局的影响得出结论。
IV级，对II级和IV级研究的系统综述。
