踝关节开放性融合术：入路与固定方法的系统评价

Open Ankle Arthrodesis: a Systematic Review of Approaches and Fixation Methods.

机构信息

Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.

Trauma and Orthopaedic Department, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom.

出版信息

Foot Ankle Surg. 2021 Apr;27(3):339-347. doi: 10.1016/j.fas.2020.12.011. Epub 2021 Jan 2.

DOI:10.1016/j.fas.2020.12.011

PMID:33419696

Abstract

BACKGROUND

Open ankle arthrodesis (OAA) remains the most widely used operation in end-stage ankle osteoarthritis. However, there is a large variation in terms of approach and fixation methods. The aim of this systematic review was to assess the effect of different approaches and fixation methods on the union rate, complication rate and functional outcome in OAA.

METHODS

A search of the online databases PubMed, Embase, and Cochrane library was performed to identify patients who underwent OAA with screw- and/or plate-fixation.

RESULTS

We identified 38 studies, including 1250 patients (1290 ankles). The union rate was 98% (95% CI 0.95-0.99) for the anterior, 96% (95% CI 0.92-0.98) for the lateral and 96% (95% CI 0.68-1.00) for the combined medial/lateral approach. Screw-fixation achieved an overall union rate of 96% (95% CI 0.93-0.98) and plate-fixation 99% (95% CI 0.96-0.99). The overall complication rate was 14%, 16% and 31% for the anterior, lateral and combined medial/lateral approaches respectively. It stood at 18% for screw-fixation and 9% for plate-fixation. The infection rate was 4%, 6% and 8% for the anterior, lateral and combined approaches respectively. Screw-fixation had an infection rate of 6% and plate-fixation 3%. The postoperative AOFAS scores were 76.8, 76.5 and 67.6 for the anterior, lateral and combined approaches respectively and 74.9 for screw- compared to 78.5 for plate-fixation. These differences did not reach statistical significance.

CONCLUSION

This study, the first of its kind, found little difference in terms of results between approach and fixation method used in OAA.

LEVEL OF EVIDENCE

Level IIa.

摘要

背景

开放式踝关节融合术（OAA）仍然是治疗晚期踝关节骨关节炎最广泛应用的手术方法。然而，在手术入路和固定方法方面存在很大差异。本系统评价的目的是评估不同入路和固定方法对 OAA 融合率、并发症发生率和功能结果的影响。

方法

在在线数据库 PubMed、Embase 和 Cochrane 图书馆中进行了搜索，以确定接受螺钉和/或钢板固定的 OAA 患者。

结果

我们共确定了 38 项研究，共包括 1250 名患者（1290 个踝关节）。前入路的融合率为 98%（95%可信区间 0.95-0.99），外侧入路为 96%（95%可信区间 0.92-0.98），内侧/外侧联合入路为 96%（95%可信区间 0.68-1.00）。螺钉固定的总体融合率为 96%（95%可信区间 0.93-0.98），钢板固定为 99%（95%可信区间 0.96-0.99）。前入路、外侧入路和内侧/外侧联合入路的总体并发症发生率分别为 14%、16%和 31%，螺钉固定为 18%，钢板固定为 9%。感染率分别为前入路 4%、外侧入路 6%和联合入路 8%，螺钉固定为 6%，钢板固定为 3%。前入路、外侧入路和联合入路的术后 AOFAS 评分分别为 76.8、76.5 和 67.6，螺钉固定为 74.9，钢板固定为 78.5。这些差异没有达到统计学意义。