Xu Baoyun, Wang Shanshan, Tan Jindong, Chen Wan, Tang Kang-Lai
Sports Medicine Center, Southwest Hospital of Army Medical University, Chongqing, China.
Department of Pain and Rehabilitation, Xinqiao Hospital of Army Medical University, Chongqing, China.
Orthop J Sports Med. 2023 Jan 5;11(1):23259671221127665. doi: 10.1177/23259671221127665. eCollection 2023 Jan.
The syndesmotic screw (SS) and suture button (SB) fixation methods are both widely used for the reduction of ankle syndesmotic injury, with varying outcomes.
To review recently published randomized controlled trials (RCTs) to assess the outcomes between SS and SB fixation for ankle syndesmotic injury.
Systematic review; Level of evidence, 1.
The PubMed, Embase, ClinicalTrials.gov, and Cochrane databases were searched for relevant RCTs published between 1966 and 2021 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies were RCTs comparing SS and SB fixation for ankle syndesmotic injury. The risk of bias was evaluated using the Cochrane Risk of Bias tool. Primary outcomes included complications, malreduction, and unplanned reoperation, and secondary outcomes were the American Orthopaedic Foot & Ankle Society (AOFAS) score, Olerud-Molander ankle score (OMAS), and EuroQol-5 Domain (EQ-5D) score. The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. Random- or fixed-effects model was applied according to heterogeneity.
Of 389 studies, 8 RCTs involving 512 patients were included. Overall, 257 patients received SS fixation and 255 patients received SB fixation. The 2 groups did not differ significantly in malreduction (RR, -0.06; 95% CI, -0.18 to 0.07) or EQ-5D (MD, 0.01; 95% CI, -0.01 to 0.03). However, the SB group showed significant advantages over the SS group in complications (RR, 0.42; 95% CI, 0.26 to 0.66), unplanned reoperation (RR, 0.62; 95% CI, 0.43 to 0.89), AOFAS score (MD, 3.04; 95% CI, 1.77 to 4.31), and OMAS (MD, 4.51; 95% CI, 1.54 to 7.48). The risk of bias of the included studies was acceptable.
The results showed that there were no significant differences between the SS and SB groups in malreduction and EQ-5D scores. However, the SB group had significantly better local irritation rates, unplanned reoperation rates, AOFAS scores, and OMASs.
下胫腓螺钉（SS）和缝线纽扣（SB）固定方法均广泛用于踝关节下胫腓损伤的复位，但其结果各异。
回顾近期发表的随机对照试验（RCT），以评估SS和SB固定治疗踝关节下胫腓损伤的疗效。
系统评价；证据等级，1级。
根据PRISMA（系统评价和Meta分析的首选报告项目）指南，检索PubMed、Embase、ClinicalTrials.gov和Cochrane数据库中1966年至2021年期间发表的相关RCT。符合条件的研究为比较SS和SB固定治疗踝关节下胫腓损伤的RCT。使用Cochrane偏倚风险工具评估偏倚风险。主要结局包括并发症、复位不良和计划外再次手术，次要结局为美国矫形足踝协会（AOFAS）评分、奥勒鲁德-莫兰德踝关节评分（OMAS）和欧洲五维健康量表（EQ-5D）评分。分别计算连续型和二分法结局的平均差（MD）和风险比（RR）。根据异质性应用随机效应或固定效应模型。
在389项研究中，纳入了8项涉及512例患者的RCT。总体而言，257例患者接受了SS固定，255例患者接受了SB固定。两组在复位不良（RR，-0.06；95%CI，-0.18至0.07）或EQ-5D（MD，0.01；95%CI，-0.01至0.03）方面无显著差异。然而，SB组在并发症（RR，0.42；95%CI，0.26至0.66）、计划外再次手术（RR，0.62；95%CI，0.43至0.89）、AOFAS评分（MD，3.04；95%CI，1.77至4.31）和OMAS（MD，4.51；95%CI，1.54至7.48）方面均显示出优于SS组的显著优势。纳入研究的偏倚风险可接受。
结果表明，SS组和SB组在复位不良和EQ-5D评分方面无显著差异。然而，SB组在局部刺激率、计划外再次手术率、AOFAS评分和OMAS方面明显更好。
