Boksh Khalis, Sharma Ashwini, Grindlay Douglas, Divall Pip, Mangwani Jitendra
Department of Trauma and Orthopaedics, Leicester Royal Infirmary, United Kingdom.
Centre for Evidence Based Hand Surgery, University of Nottingham, United Kingdom.
J Clin Orthop Trauma. 2020 May-Jun;11(3):508-513. doi: 10.1016/j.jcot.2020.03.019. Epub 2020 Apr 3.
Lisfranc injuries are relatively uncommon but carry devastating consequences if left untreated. Although many surgical techniques have been proposed for best operative management, there is an ongoing debate over which procedure is superior. We performed a systematic review and meta-analysis comparing the outcomes of transarticular screw fixation and dorsal bridge plating in management of Lisfranc injuries. Ovid MEDLINE, Ovid Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomised controlled trials (RCTs) and cohort studies comparing the outcomes between screw and dorsal plate fixation. The pooled outcome data were calculated by random and fixed effect models. One prospective cohort and three retrospective studies were identified with a total of 210 patients with mean follow up of 40.6 months. All papers were analysed for quality using the modified Newcastle Ottawa score. The results show that dorsal bridge plating is associated with better American Orthopaedic Foot and Ankle Society score (AOFAS) compared with transarticular screw fixation (OR - 0.71, 95% CI -1.31 to -0.10, p = 0.02). Dorsal plating may also be associated with fewer cases of arthritis, although this was not significant (OR 2.46, 95% CI 0.89 to 6.80, p = 0.08). We found no significant differences between the groups in terms of Foot Function Index (FFI), post traumatic arthritis and failure of hardware material. Although our results suggest dorsal bridge plating may provide superior functional outcomes, there is a scarcity of literature with little robustness to make definitive conclusions. High quality randomised trials are required.
Lisfranc损伤相对不常见，但如果不治疗会带来灾难性后果。尽管已经提出了许多手术技术用于最佳手术治疗，但对于哪种手术方法更优仍存在争议。我们进行了一项系统评价和荟萃分析，比较经关节螺钉固定和背侧桥接钢板固定治疗Lisfranc损伤的疗效。检索了Ovid MEDLINE、Ovid Embase和Cochrane对照试验中央注册库（CENTRAL），以确定比较螺钉固定和背侧钢板固定疗效的随机对照试验（RCT）和队列研究。汇总的结局数据通过随机效应模型和固定效应模型计算。共纳入1项前瞻性队列研究和3项回顾性研究，总计210例患者，平均随访40.6个月。使用改良的纽卡斯尔渥太华评分对所有论文进行质量分析。结果显示，与经关节螺钉固定相比，背侧桥接钢板固定后的美国矫形足踝协会评分（AOFAS）更高（OR = -0.71，95%CI -1.31至-0.10，p = 0.02）。背侧钢板固定的关节炎病例数可能也较少，尽管差异不显著（OR = 2.46，95%CI 0.89至6.80，p = 0.08）。我们发现两组在足部功能指数（FFI）、创伤后关节炎和硬件材料失效方面无显著差异。尽管我们的结果表明背侧桥接钢板固定可能提供更好的功能结局，但相关文献较少，缺乏足够的稳健性来得出明确结论。需要高质量的随机试验。
