关节镜与开放式踝关节融合术治疗晚期踝关节关节炎的临床疗效：系统评价和荟萃分析。

Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis: A systematic review and meta-analysis.

机构信息

Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.

出版信息

Medicine (Baltimore). 2021 Mar 12;100(10):e24998. doi: 10.1097/MD.0000000000024998.

DOI:10.1097/MD.0000000000024998

PMID:33725876

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7969227/

Abstract

BACKGROUND

Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion.

OBJECTIVE

To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis.

METHODS

We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software.

RESULTS

A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = -2.31, 95% CI:-4.63, -2.21), intraoperative blood loss (MD = -43.37, 95%CI: -48.49, -38.25), hospital stay (MD = -1.80, 95%CI: -2.28, -1.33), and visual analog scale score (MD = -1.75, 95%CI: -2.04, -1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001).

CONCLUSION

Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application.

PROSPERO REGISTRATION NUMBER

CRD42020195727.

摘要

背景

踝关节融合术是治疗晚期踝关节关节炎的主要方法。随着关节镜技术的进步，踝关节关节镜融合术已显示出优于传统手术的许多优势。然而，全球相关研究较少，需要循证医学来验证踝关节关节镜融合术的可靠性和可行性。

目的

比较关节镜下踝关节融合术与开放性踝关节融合术的临床疗效和安全性。

方法

我们检索了 PubMed、Embase、Cochrane 图书馆、中国知网[CNKI]、万方数据库和 VIP 数据库中关于关节镜辅助踝关节融合术治疗晚期踝关节关节炎的前瞻性或回顾性对照研究。检索时间限定为各数据库建库至 2019 年 6 月 30 日。文献检索、数据提取和质量评估由 2 名独立的评价员根据循证医学的原则和方法进行。使用 Cochrane 5.1 偏倚风险评估工具评估文献的方法学偏倚，并使用 RevMan 5.3 软件进行荟萃分析。

结果

共纳入 18 项研究，1102 例患者，其中关节镜手术组 551 例，开放手术组 551 例。对于晚期踝关节关节炎患者，关节镜辅助手术在融合率（比值比[OR] = 3.32，95%置信区间[CI]：2.16，5.10）、融合时间（均数差[MD] = -2.31，95%CI：-4.63，-2.21）、术中出血量（MD = -43.37，95%CI：-48.49，-38.25）、住院时间（MD = -1.80，95%CI：-2.28，-1.33）和视觉模拟评分（MD = -1.75，95%CI：-2.04，-1.46）方面均优于开放手术。此外，并发症发生率（OR = 0.33，95%CI：0.21，0.52）也优于开放性踝关节融合术（P < 0.00001）。