Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Lebanese American University, Beirut, Lebanon.
The Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
Eur J Trauma Emerg Surg. 2021 Aug;47(4):1221-1230. doi: 10.1007/s00068-019-01236-9. Epub 2019 Oct 12.
Though uncommon, Lisfranc complex joint injuries constitute a therapeutic challenge. Two surgical methods are commonly used to treat such injuries: open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The aim of this meta-analysis is to look for significant differences in the outcomes between these two techniques.
A comprehensive search of databases including PubMed, Embase, Cochrane Library and Google Scholar was planned. Only studies with comparative design using ORIF/PA techniques were included. One randomized trial, one quasi-randomized trial and four of retrospective comparative studies met the inclusion criteria. Proportion meta-analysis was used to look for weighted frequencies of outcomes. Risk difference rate meta-analysis was conducted to look for significant differences between proportion rates.
The pooled sample included 269 patients [269 surgical procedures: 176 (65.4%) ORIF vs. 93 (34.6%) PA] with a mean follow-up period of 31.85 ± 16.14 months. Besides a similar radiological healing failure rate, meta-analytical results yielded better outcomes in favour of PA: lesser implant removal rate (P < 0.0001), better rate of return to full activities (P = 0.01) and satisfaction rate (P = 0.052). A double rate of revision for non-healing following ORIF was found but did not reach significance (P = 0.1).
This meta-analysis demonstrated that even with a similar union rate, PA could be a better option in treating Lisfranc complex joint injuries when compared to ORIF. There is a need for larger controlled sampled studies to research on this type of injuries.
尽管罕见，Lisfranc 复合关节损伤仍是治疗难题。两种常用的手术方法治疗此类损伤：切开复位内固定（ORIF）和一期融合术（PA）。本荟萃分析旨在寻找这两种技术之间结果的显著差异。
计划对包括 PubMed、Embase、Cochrane 图书馆和 Google Scholar 在内的数据库进行全面检索。仅纳入使用 ORIF/PA 技术的比较设计研究。符合纳入标准的研究有 1 项随机试验、1 项准随机试验和 4 项回顾性比较研究。采用比例荟萃分析寻找结局的加权频率。采用风险差异率荟萃分析寻找比例率之间的显著差异。
汇总样本包括 269 例患者[269 例手术：176 例（65.4%）ORIF 与 93 例（34.6%）PA]，平均随访时间为 31.85±16.14 个月。除了相似的影像学愈合失败率外，荟萃分析结果显示 PA 更优：内固定去除率更低（P<0.0001），完全活动恢复率更好（P=0.01）和满意度更高（P=0.052）。ORIF 后非愈合的翻修率呈双倍数增加，但未达到显著性（P=0.1）。
本荟萃分析表明，即使在愈合率相似的情况下，与 ORIF 相比，PA 治疗 Lisfranc 复合关节损伤可能是更好的选择。需要进行更大规模的、有对照样本的研究来探究此类损伤。
