Department of Foot and Ankle Surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
J Orthop Surg Res. 2020 Feb 26;15(1):80. doi: 10.1186/s13018-020-01599-5.
A great deal of research suggests that arthroscopic ankle fusion (AAF) has advantages over open ankle fusion (OAF), but these outcomes would be imprecise because of a selection bias. The purpose of this study is to verify which is better for ankle fusion, AAF or OAF. We regrouped the OAF group into two subgroups according to whether the osseous operation type is the same as AAF group. The goal is to minimize the impact of disease severity, thereby reducing selection bias to some extent.
We retrospectively analyzed the data of ankle fusion in our hospital between July 2015 and October 2018. Forty-three patients were enrolled and divided into AAF group (n = 17) and OAF group (n = 26). In order to eliminate selection bias, we divided OAF group into complex osseous operation subgroup (COO subgroup) (n = 15) and simple osseous operation subgroup (SOO subgroup) (n = 11). The osseous operation type of SOO subgroup is the same as AAF group. Then, we compared the differences between these groups. All patients were followed up at least 1 year after operation. We analyzed data, including etiology composition, surgical time, intra-op blood loss, reduction of albumin, total hospital stays, union time, fusion situation, complications, radiological examination, functional score, and questionnaire survey. Then we performed statistical analyses.
We found that the etiological components of AAF group and OAF group were different; the etiological components of AAF group and SOO subgroup were similar. We found that AAF group has advantages over OAF group and COO subgroup in general. However, except in terms of surgical trauma, hospital stays, and short-term complications occurred, the AAF group has not obvious advantages over SOO subgroup, including intra-op blood loss, fusion condition, postoperative function score, and postoperative patient satisfaction; and AAF group need more surgical time than the SOO subgroup.
The arthroscopic ankle fusion can bring a good curative effect; however, if the osseous operation type is the same, the arthroscopic ankle fusion only has a limited advantage over the traditional open operation in perioperative soft tissue protection and enhanced recovery after surgery.
大量研究表明，关节镜下踝关节融合术（AAF）优于开放式踝关节融合术（OAF），但由于选择偏倚，这些结果可能不够准确。本研究旨在验证踝关节融合术，AAF 或 OAF，哪种方法更好。我们根据骨操作类型是否与 AAF 组相同，将 OAF 组重新分为两个亚组。目的是尽量减少疾病严重程度的影响，从而在一定程度上减少选择偏倚。
我们回顾性分析了 2015 年 7 月至 2018 年 10 月我院踝关节融合术的资料。共纳入 43 例患者，分为 AAF 组（n=17）和 OAF 组（n=26）。为了消除选择偏倚，我们将 OAF 组分为复杂骨操作亚组（COO 亚组）（n=15）和简单骨操作亚组（SOO 亚组）（n=11）。SOO 亚组的骨操作类型与 AAF 组相同。然后，我们比较了这些组之间的差异。所有患者术后至少随访 1 年。我们分析了数据，包括病因构成、手术时间、术中失血量、白蛋白减少、总住院时间、愈合时间、融合情况、并发症、影像学检查、功能评分和问卷调查。然后我们进行了统计分析。
我们发现 AAF 组和 OAF 组的病因构成不同；AAF 组和 SOO 亚组的病因构成相似。我们发现 AAF 组总体上优于 OAF 组和 COO 亚组。然而，除了手术创伤、住院时间和短期并发症外，AAF 组与 SOO 亚组相比并没有明显的优势，包括术中失血量、融合情况、术后功能评分和术后患者满意度；而且 AAF 组的手术时间比 SOO 亚组长。
关节镜下踝关节融合术可带来良好的疗效；然而，如果骨操作类型相同，关节镜下踝关节融合术在围手术期软组织保护和术后快速康复方面仅比传统开放式手术具有有限的优势。
