Liu Jiayong, Pathak Gautam, Joshi Mihir, Andrews Kyle, Lee Joseph
Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, USA.
J Orthop. 2021 Apr 24;25:82-87. doi: 10.1016/j.jor.2021.04.006. eCollection 2021 May-Jun.
Currently there is significant controversy regarding which fixation method is most effective for the treatment of syndesmotic ankle injuries.
This meta-analysis was designed to compare the metal screw, dynamic, and bioabsorbable screw fixation methods for treatment of syndesmotic ankle injuries.
An online search for RCT and prospective/retrospective clinical comparison studies between January 1998 and December 2018 on syndesmotic fixation was conducted. The main parameters collected include functional scores, mean time to full weightbearing, postoperative tibiofibular clear spaces, tibiofibular overlap, medial clear spaces, and complication rates. Statistical analysis was conducted using One Way ANOVAs and Chi-Squared tests using Review Manager and Excel.
A total of 18 comparison studies, with 509 patients in the metal screw fixation group, 275 in the dynamic fixation group, and 226 in the bioabsorbable screw fixation group, were included in this meta-analysis. For the metal screw group, dynamic fixation group, and bioabsorbable screw group, the mean AOFAS score were 83.8, 87.2, and 84.3 (p < 0.05), the mean time to full weightbearing were 9.0 weeks, 7.2 weeks, and 7.7 weeks (p < 0.05), and the complication rates were 0.19, 0.09, and 0.19, respectively (p < 0.05). Similarly, the mean postoperative TFCS were 4.85, 3.87, and 5.70 for the metal screw group, dynamic fixation group, and bioabsorbable screw fixation group, respectively (p < 0.05).
The dynamic fixation group was found to have significantly improved functional scores, lower complication rates, and lower mean time to full weight-bearing than the metal screw and bioabsorbable screw fixation methods.
Meta-analysis of all relevant Level 1-3 Evidence Comparative Studies.
目前，对于治疗下胫腓联合踝关节损伤哪种固定方法最有效存在重大争议。
本荟萃分析旨在比较金属螺钉、动力性和生物可吸收螺钉固定方法治疗下胫腓联合踝关节损伤的效果。
对1998年1月至2018年12月期间关于下胫腓联合固定的随机对照试验（RCT）以及前瞻性/回顾性临床比较研究进行在线检索。收集的主要参数包括功能评分、完全负重的平均时间、术后胫腓间隙、胫腓重叠、内侧间隙和并发症发生率。使用Review Manager和Excel进行单因素方差分析和卡方检验。
本荟萃分析共纳入18项比较研究，其中金属螺钉固定组509例患者，动力性固定组275例患者，生物可吸收螺钉固定组226例患者。金属螺钉组、动力性固定组和生物可吸收螺钉组的美国足踝外科协会（AOFAS）平均评分分别为83.8、87.2和84.3（p<0.05），完全负重的平均时间分别为9.0周、7.2周和7.7周（p<0.05），并发症发生率分别为0.19、0.09和0.19（p<0.05）。同样，金属螺钉组、动力性固定组和生物可吸收螺钉固定组术后胫腓联合间隙（TFCS）的平均值分别为4.85、3.87和5.70（p<0.05）。
与金属螺钉和生物可吸收螺钉固定方法相比，动力性固定组的功能评分显著提高，并发症发生率更低，完全负重的平均时间更短。
对所有相关的1-3级证据比较研究进行荟萃分析。
