Li Bin, Xie Jianying, Zhang Zhengmao, Liu Quanyong, Xu Jialie, Yang Chenxi
Department of Orthopaedics, Yuhuan People's Hospital, Taizhou, China.
Front Surg. 2023 Jan 25;9:1055008. doi: 10.3389/fsurg.2022.1055008. eCollection 2022.
Both casts and braces can be used for post-operational immobilization of ankle fractures. This meta-analysis aimed to assess the complications and functional effects of the two types of immobilization.
PubMed, Embase, Cochrane, and CNKI was searched for randomized controlled trials (published between Jan 1, 1950, and March 2022). Relative risk (RR) or standard mean difference (SMD) with a 95% confidence interval (CI) was used to present the outcomes. The pooled data were assessed by using the fixed-effects model or random-effects model.
A total of 5 randomized controlled studies involving 930 subjects were included according to our inclusion criteria. On the ankle score at 6w,12w and 52w, there was no statistically significant difference between the two groups. In terms of 6w, the brace group showed better ankle dorsiflexion (MD = 6.78, 95% CI 0.56-13.00, = 0.03) and plantar flexion (MD = 6.58, 95% CI 1.60-11.55, = 0.01) than the cast group. The wound complications (RR = 3.49, 95% CI 1.32 to 9.24, = 0.01) and total complications (RR = 3.54, 95% CI 1.92 to 6.50, < 0.0001) in the brace group were three times more than that in the cast group. There was no statistically significant difference between the two groups in the non-wound complications. There was no statistically significant difference between the two groups in the time of going back to work, swelling of the ankle, and atrophy of the calf muscle.
The short-term and long-term functional outcomes after postoperative treatment of adult ankle fractures with braces are similar to those with casts. The usage of braces may cause three times more wound complications than that of casts.
石膏和支具均可用于踝关节骨折术后的固定。本荟萃分析旨在评估这两种固定方式的并发症及功能效果。
检索PubMed、Embase、Cochrane和中国知网中1950年1月1日至2022年3月发表的随机对照试验。采用相对危险度（RR）或标准化均数差（SMD）及95%置信区间（CI）来呈现结果。使用固定效应模型或随机效应模型对汇总数据进行评估。
根据纳入标准，共纳入5项涉及930名受试者的随机对照研究。在术后6周、12周和52周的踝关节评分上，两组之间无统计学显著差异。在术后6周时，支具组的踝关节背屈（MD = 6.78，95%CI 0.56 - 13.00，P = 0.03）和跖屈（MD = 6.58，95%CI 1.60 - 11.55，P = 0.01）较石膏组更好。支具组的伤口并发症（RR = 3.49，95%CI 1.32至9.24，P = 0.01）和总并发症（RR = 3.54，95%CI 1.92至6.50，P < 0.0001）是石膏组的三倍。两组在非伤口并发症方面无统计学显著差异。两组在恢复工作时间、踝关节肿胀及小腿肌肉萎缩方面无统计学显著差异。
成人踝关节骨折术后使用支具治疗的短期和长期功能结果与使用石膏相似。使用支具可能导致的伤口并发症比使用石膏多两倍。
