80%的患者在距下关节融合术后恢复良好：对 1284 例融合病例的系统回顾。
8 out of 10 patients do well after surgery for tarsal coalitions: A systematic review on 1284 coalitions.
机构信息
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
出版信息
Foot Ankle Surg. 2022 Oct;28(7):1110-1119. doi: 10.1016/j.fas.2022.03.011. Epub 2022 Mar 24.
BACKGROUND
The primary aim was to determine the clinical success rate after treatment for talocalcaneal (TCC) and calcaneonavicular coalitions (CNC). The secondary aim was to evaluate the complication, recurrence and revision rate.
METHODS
A search was carried out in MEDLINE, EMBASE and Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) criteria. The primary outcome was the clinical success rate and was pooled per type of coalition and treatment modality. 95% Confidence Intervals (CI) of the success rates were calculated. Secondary outcomes included complication rates, coalition recurrence rates, revision rates and pain improvement using the Visual Analogue Scale (VAS). A sub-analysis on interposition material was performed.
RESULTS
43 articles comprising of 1284 coalitions were included, with a pooled mean follow-up of 51 months. Methodological quality was fair. The overall pooled success rate for TCCs was 79% (95% CI, 75%-83%). Conservative treatment, open resection and arthroscopic resection of TCCs resulted in success rates of 58% (95% CI, 42%-73%), 80% (95% CI, 76%-84%) and 86% (95% CI, 71%-94%), respectively. CNCs have an overall success rate of 81% (95% CI, 75%-85%), with 100% (95% CI, 34%-100%), 80% (95% CI, 74%-85%) and 100% (95% CI, 65%-100%) for conservative treatment, open resection and arthroscopic resection, respectively. Pooled complication rates of 4% (95% CI, 3%-7%) for TCCs and 6% (95% CI, 4%-11%) for CNCs were found. The success rates of resection with and without interposition material for TCCs were 83% (95% CI, 78%-87%) and 79% (95% CI, 65%-88%), and for CNCs 81% (95% CI, 76%-86%) and 69% (95% CI, 44%-85%), respectively.
CONCLUSION
Treatment of tarsal coalitions can be considered good to excellent as well as safe, with an overall clinical success rate of 79% for TCCs and 81% for CNCs. Arthroscopic resection of the coalition appears to be non-inferior to open resection of TCCs and CNCs.
LEVEL OF EVIDENCE
Level IV, Systematic Review.
背景
本研究的主要目的是确定距跟（TCC）和跟舟（CNC）骨联合治疗后的临床成功率。次要目的是评估并发症、复发和翻修率。
方法
在 MEDLINE、EMBASE 和 Cochrane 图书馆进行了检索。使用非随机研究方法学指数（MINORS）标准评估方法学质量。主要结局是临床成功率，并按联合类型和治疗方式进行汇总。计算成功率的 95%置信区间（CI）。次要结局包括使用视觉模拟量表（VAS）评估并发症发生率、联合复发率、翻修率和疼痛改善情况。对介入材料进行了亚分析。
结果
共纳入 43 篇文章，包含 1284 个联合，平均随访时间为 51 个月。方法学质量为中等。TCC 的总体汇总成功率为 79%（95%CI，75%-83%）。TCC 的保守治疗、开放切除和关节镜切除的成功率分别为 58%（95%CI，42%-73%）、80%（95%CI，76%-84%）和 86%（95%CI，71%-94%）。CNC 的总体成功率为 81%（95%CI，75%-85%），保守治疗、开放切除和关节镜切除的成功率分别为 100%（95%CI，34%-100%）、80%（95%CI，74%-85%）和 100%（95%CI，65%-100%）。TCC 的汇总并发症发生率为 4%（95%CI，3%-7%），CNC 的并发症发生率为 6%（95%CI，4%-11%）。TCC 切除合并和不合并介入材料的成功率分别为 83%（95%CI，78%-87%）和 79%（95%CI，65%-88%），CNC 的成功率分别为 81%（95%CI，76%-86%）和 69%（95%CI，44%-85%）。
结论
跗骨联合的治疗效果良好，安全性高，TCC 的总体临床成功率为 79%，CNC 的总体临床成功率为 81%。关节镜切除联合与开放切除 TCC 和 CNC 相比似乎并不劣效。
证据水平
四级，系统评价。
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