Luo Xiangping, Li Qi, He Shengmao, He Shunqing
Orthopedist, Department of Orthopaedic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
Professor, Department of Orthopaedic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
J Foot Ankle Surg. 2016 Jul-Aug;55(4):821-8. doi: 10.1053/j.jfas.2016.01.035. Epub 2016 Apr 15.
The purpose of the present study was to perform an updated meta-analysis of the operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in adults. We searched the Cochrane Library, MEDLINE, EMBASE, and Google Scholar for eligible studies. All published randomized controlled trials comparing operative with nonoperative treatment for displaced intra-articular calcaneal fractures were eligible. The meta-analysis was performed using RevMan, version 5.0, software. Seven studies assessing 824 patients were eligible for the meta-analysis. The pooled results indicated no significant differences between the 2 groups with regard to the functional results. The incidence of complications was 25.0% (80 of 319) in the operative group and 16.6% (55 of 330) in the nonoperative group (relative risk 1.53, 95% confidence interval 1.13 to 2.08; p = .006) with a significant difference. The rate of subtalar arthrodesis was significantly lower in the operative group than in the nonoperative group. The current evidence is still insufficient to ascertain whether operative treatment is superior to nonoperative treatment for displaced intra-articular calcaneal fractures. Operative treatment can reduce the risk of late subtalar arthrodesis but is associated with a greater risk of complications. The small sample size and the great heterogeneity of the included studies made it difficult to draw conclusions regarding some of the combined results. Furthermore, more high-quality, randomized controlled trials with long-term follow-up data on this issue are required to provide evidence for surgeons to make an informed decision.
本研究的目的是对成人移位性关节内跟骨骨折的手术治疗与非手术治疗进行一项更新的荟萃分析。我们在Cochrane图书馆、MEDLINE、EMBASE和谷歌学术搜索了符合条件的研究。所有已发表的比较移位性关节内跟骨骨折手术治疗与非手术治疗的随机对照试验均符合条件。使用RevMan 5.0软件进行荟萃分析。七项评估824例患者的研究符合荟萃分析的条件。汇总结果表明，两组在功能结果方面无显著差异。手术组并发症发生率为25.0%（319例中的80例），非手术组为16.6%（330例中的55例）（相对风险1.53，95%置信区间1.13至2.08；p = 0.006），存在显著差异。手术组距下关节融合率显著低于非手术组。目前的证据仍不足以确定移位性关节内跟骨骨折的手术治疗是否优于非手术治疗。手术治疗可降低晚期距下关节融合的风险，但并发症风险更高。纳入研究的样本量小且异质性大，难以就一些合并结果得出结论。此外，需要更多关于此问题的高质量、有长期随访数据的随机对照试验，为外科医生做出明智决策提供证据。
