Yang XiaoLing, Zeng Jianshuang, Yang Wei, Dela Rosa Ronnell D, Jiang Zhixia
Department of Nursing, Guizhou Nursing Vocational College, Guiyang, People's republic of China.
School of Nursing, Philippine Women's University, Manila, Philippines.
Front Surg. 2023 Mar 27;10:976181. doi: 10.3389/fsurg.2023.976181. eCollection 2023.
Ankle fracture combined with deltoid ligament (DL) injury results in decreased stability of ankle mortise, reduced contact surface between tibial and talus, increased local stress, and increased postoperative complications. The purpose of this meta-analysis was to evaluate the postoperative effects of repairing ligaments in ankle fractures with DL rupture.
According to the steps of the Cochrane systematic review, the related literatures from PubMed, Embase and the Cochrane Library Databases were retrieved as of September 1, 2021, and all relevant randomized controlled trials and retrospective studies were collected. The evaluation indicators include medial clear space (MCS), visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), complications rate. Meta-analysis was conducted by RevMan® 5.3 provided by the Cochrane collaboration.
A total of 388 patients (195 patients in the ligament repair group and 193 patients in the non-repair group) were included in 7 clinical trials. Meta-analysis data showed there were no statistically significant differences between the ligament repair group and non-repair group in final follow-up VAS, final AOFAS and postoperative MCS ( = 0.50, = 0.04, = 0.14, = 0.14, respectively). Final follow-up MCS and complications rate in ligament repair group were smaller than those in the non-repair group and were statistically significant ( < 0.00001, = 0.006, respectively).
Although there was no difference in in final follow-up VAS, final follow-up AOFAS and postoperative MCS between experimental group and control group, It's statistically significant in final follow-up MCS and complications rate. Ligament repair could reduce the width of MCS, restore ankle stability, reduce the incidence of complications and lead to a better prognosis.
踝关节骨折合并三角韧带（DL）损伤会导致踝关节 mortise 稳定性下降、胫骨与距骨之间的接触面积减小、局部应力增加以及术后并发症增多。本荟萃分析的目的是评估修复伴有 DL 断裂的踝关节骨折韧带的术后效果。
按照 Cochrane 系统评价的步骤，检索截至 2021 年 9 月 1 日来自 PubMed、Embase 和 Cochrane 图书馆数据库的相关文献，并收集所有相关的随机对照试验和回顾性研究。评估指标包括内侧间隙（MCS）、视觉模拟量表（VAS）、美国矫形足踝协会（AOFAS）、并发症发生率。由 Cochrane 协作网提供的 RevMan® 5.3 进行荟萃分析。
7 项临床试验共纳入 388 例患者（韧带修复组 195 例，非修复组 193 例）。荟萃分析数据显示，韧带修复组与非修复组在末次随访 VAS、末次 AOFAS 和术后 MCS 方面无统计学显著差异（分别为 = 0.50， = 0.04， = 0.14， = 0.14）。韧带修复组的末次随访 MCS 和并发症发生率低于非修复组，且具有统计学显著性（分别为 < 0.00001， = 0.006）。
虽然实验组与对照组在末次随访 VAS（视觉模拟评分）、末次随访 AOFAS（美国矫形足踝协会评分）和术后 MCS（内侧间隙）方面无差异，但在末次随访 MCS 和并发症发生率方面具有统计学显著性。韧带修复可减小 MCS 的宽度，恢复踝关节稳定性，降低并发症发生率，并带来更好的预后。
