Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, Texas.
Foot Ankle Spec. 2022 Apr;15(2):171-178. doi: 10.1177/1938640020971417. Epub 2020 Nov 12.
The superiority of primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in Lisfranc injuries has been debated. Meta-analyses comparing these surgical options have reached contradicting conclusions. The goal of this article is to determine why different conclusions were reached and provide clarity on the comparable outcomes of PA and ORIF in Lisfranc injuries.
A systematic literature review was conducted by searching for "meta-analysis" AND "Lisfranc" with keywords such as "ORIF" OR "open reduction" OR "arthrodesis" OR "fusion." Five meta-analysis articles discussing PA and ORIF in Lisfranc injuries were identified. Study outcomes were extracted from each article, and contradicting conclusions were identified for analysis.
PA had lower rates of hardware removal. There was no difference between PA and ORIF when considering revision surgery, anatomic reduction, postoperative infection, total complications, and patient satisfaction. However, contradicting conclusions were reached for return to duty, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and visual analogue scale (VAS) score. Conclusions. There was no difference in PA and ORIF for return to work and VAS score. Repeat meta-analysis with truly equivocal outcomes would be necessary to reach a valid conclusion for return to full activity and AOFAS midfoot scores.
Level II: Therapeutic studies.
在 Lisfranc 损伤中，初次关节融合术（PA）优于切开复位内固定术（ORIF）的观点一直存在争议。比较这些手术选择的荟萃分析得出了相互矛盾的结论。本文的目的是确定为什么会得出不同的结论，并阐明 PA 和 ORIF 在 Lisfranc 损伤中的可比结果。
通过搜索“meta-analysis”和“Lisfranc”并使用“ORIF”或“open reduction”或“arthrodesis”或“fusion”等关键字，进行了系统的文献回顾。确定了 5 篇讨论 Lisfranc 损伤中 PA 和 ORIF 的荟萃分析文章。从每篇文章中提取研究结果，并确定分析具有矛盾结论的结果。
PA 的内固定去除率较低。PA 和 ORIF 在考虑翻修手术、解剖复位、术后感染、总并发症和患者满意度方面没有差异。然而，在重返工作、美国矫形足踝协会（AOFAS）评分和视觉模拟评分（VAS）方面得出了相互矛盾的结论。结论：PA 和 ORIF 在重返工作和 VAS 评分方面没有差异。对于重返全活动和 AOFAS 中足评分，需要进行真正模棱两可的结果的重复荟萃分析，才能得出有效的结论。
II 级：治疗研究。
