Engelmann Esmee Wilhelmina Maria, Roelofs Anne, Posthuma Jelle, Schepers Tim
Trauma Unit, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands.
Trauma Unit, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands.
J Foot Ankle Surg. 2022 Nov-Dec;61(6):1267-1274. doi: 10.1053/j.jfas.2022.03.002. Epub 2022 Mar 12.
The optimal treatment strategy of Lisfranc injury is still in debate. This study aimed to compare the functional outcome and complications of dorsal bridge plating (BP) and transarticular screws (TAS). A systematic review and meta-analysis of the present literature was performed. PubMed, EMBASE, and Cochrane databases were searched using set search criteria and date range January 2000 to July 26, 2021. Randomized controlled trials (RCTs) and observational comparative studies concerning the outcome of dorsal BP and TAS for the fixation of Lisfranc injuries were eligible for inclusion. Random effect models were used to analyze pooled data. Forest plots using 95% confidence intervals (CI) were created to illustrate mean differences and odds ratios. Four observational studies were eligible for inclusion, including 111 patients in the BP group and 87 patients in the TAS group. American Orthopaedic Foot & Ankle Society (AOFAS) score was significantly higher in the BP group (mean difference 7.08, 95% CI 1.50-12.66, p = .01). Osteoarthritis was significantly less common in the BP group compared to the TAS group (odds ratio 0.45, 95% CI 0.22-0.94, p = .03). No significant difference was found between the groups in terms of postoperative infection, hardware removal, chronic pain, and secondary arthrodesis. Dorsal bridge plating of fractures in the Lisfranc joint may lead to better functional outcome and a lower incidence of post-traumatic arthritis when compared to transarticular screws. A larger body of high-quality evidence is required to independently analyze the severity of fractures in the different columns involved and subsequent outcomes of operative management.
Lisfranc损伤的最佳治疗策略仍存在争议。本研究旨在比较背侧桥接钢板固定术（BP）和经关节螺钉固定术（TAS）的功能结局及并发症。对现有文献进行了系统综述和荟萃分析。使用设定的检索标准，在PubMed、EMBASE和Cochrane数据库中进行检索，检索日期范围为2000年1月至2021年7月26日。纳入关于背侧BP和TAS固定Lisfranc损伤结局的随机对照试验（RCT）和观察性比较研究。采用随机效应模型分析汇总数据。绘制了使用95%置信区间（CI）的森林图，以说明平均差异和比值比。四项观察性研究符合纳入标准，BP组111例患者，TAS组87例患者。BP组的美国矫形足踝协会（AOFAS）评分显著更高（平均差异7.08，95%CI 1.50 - 12.66，p = 0.01）。与TAS组相比，BP组骨关节炎的发生率显著更低（比值比0.45，95%CI 0.22 - 0.94，p = 0.03）。两组在术后感染、内固定取出、慢性疼痛和二次关节融合方面未发现显著差异。与经关节螺钉相比，Lisfranc关节骨折的背侧桥接钢板固定术可能导致更好的功能结局和更低的创伤后关节炎发生率。需要更多高质量证据来独立分析不同柱中骨折的严重程度以及手术治疗的后续结局。
