Guo Wenxuan, Wu Fan, Chen Wenhuan, Tian Kun, Zhuang Rujie, Pan Yu
Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
J Foot Ankle Surg. 2023 Jan-Feb;62(1):178-185. doi: 10.1053/j.jfas.2022.10.003. Epub 2022 Oct 13.
The standard surgical treatment for unstable ankle fractures involves open reduction and internal fixation (ORIF) with plates. However, ORIF has been associated with several complications, such as soft tissue irritation, wound infection, and nerve injury. Previous studies have shown that closed reduction and internal fixation with locked intramedullary nails (LIMNs) yields satisfactory efficacy in the treatment of ankle fractures and is associated with low complication rates. Therefore, a systematic review and meta-analysis of randomized controlled trials is imperative to provide evidence on whether or not LIMN fixation is comparable to or superior than traditional ORIF. We conducted a comprehensive literature search in the PubMed, Cochrane Library and EMBASE databases. A total of 4 randomized controlled trials involving 359 participants who suffered ankle fractures were included in this systematic review and meta-analysis. The results showed that the LIMN fixation group was statistically significant in terms of functional outcomes at the 3-month follow-up and wound-related complications. There was no statistical advantage for patients in the LIMN fixation group in terms of nonwound-related complications, total complications, or mid-term follow-up functional outcomes. There was no statistical difference between the LIMN and ORIF groups regarding operation time and quality of reduction. We believe LIMN fixation is a viable option for the treatment of unstable ankle fractures in both young and elderly individuals.
不稳定型踝关节骨折的标准外科治疗方法包括使用钢板进行切开复位内固定（ORIF）。然而，ORIF与多种并发症相关，如软组织刺激、伤口感染和神经损伤。先前的研究表明，采用锁定髓内钉（LIMN）进行闭合复位内固定在治疗踝关节骨折方面疗效令人满意，且并发症发生率较低。因此，进行一项关于随机对照试验的系统评价和荟萃分析，对于提供LIMN固定是否与传统ORIF相当或更优的证据至关重要。我们在PubMed、Cochrane图书馆和EMBASE数据库中进行了全面的文献检索。本系统评价和荟萃分析共纳入了4项涉及359例踝关节骨折患者的随机对照试验。结果显示，在3个月随访时，LIMN固定组在功能结局和伤口相关并发症方面具有统计学意义。在非伤口相关并发症、总并发症或中期随访功能结局方面，LIMN固定组患者没有统计学优势。LIMN组和ORIF组在手术时间和复位质量方面没有统计学差异。我们认为，LIMN固定对于治疗年轻和老年不稳定型踝关节骨折都是一种可行的选择。
