Alberta Institute, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China.
PLoS One. 2023 Aug 4;18(8):e0289554. doi: 10.1371/journal.pone.0289554. eCollection 2023.
Arthroscopically assisted reduction and internal fixation (ARIF) allows for the assessment of joint congruity following anatomic reduction, identification of occult intra-articular lesions, and treatment of traumatic intra-articular pathologies. The aim of this systematic review and meta-analysis was to provide evidence on whether ARIF is an alternative treatment protocol for ankle fractures.
The PubMed, Embase, and Cochrane Library databases were searched independently by two investigators from the inception dates to October 9, 2022, for comparative studies. The risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials and the methodological index for non-randomized studies (MINORS) were used for assessing the methodological quality. Outcomes were evaluated in terms of the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, post-operative complications, arthroscopic findings, Visual Analogue Scale (VAS) score, and operation time. Cochrane Review Manager Software 5.4 was used to perform the statistical analysis.
A total of 10 trials involving 755 patients were included in this meta-analysis. The results revealed that ARIF for ankle fractures was superior regarding functional outcomes and VAS scores when compared with open reduction and internal fixation (ORIF). No significant difference was noted in the post-operative complication rate and the operation time between the ARIF and ORIF groups. A high incidence of chondral or osteochondral lesions (OCLs), ligamentous injuries, and loose bodies with ankle fractures was found by ankle arthroscopy.
ARIF for ankle fractures might be beneficial to offer superior functional outcomes and VAS score than ORIF. Orthopedic surgeons should take a high incidence of OCLs and ligamentous injuries into consideration for the treatment of acute ankle fractures. We believe that with the increase in surgical experience, the occurrence of post-operative complications and the extension of operation time will no longer be a potential concern for surgeons.
关节镜辅助复位内固定（ARIF）可在解剖复位后评估关节吻合度，确定隐匿性关节内损伤，并治疗创伤性关节内病变。本系统评价和荟萃分析的目的是提供 ARIF 是否是踝关节骨折的替代治疗方案的证据。
两名研究者从成立日期到 2022 年 10 月 9 日，独立检索了 PubMed、Embase 和 Cochrane Library 数据库，以查找比较研究。采用 Cochrane 协作随机对照试验风险偏倚工具和非随机研究方法学指数（MINORS）评估方法学质量。使用 Olerud-Molander 踝关节评分（OMAS）、美国矫形足踝协会（AOFAS）踝关节-后足评分、术后并发症、关节镜检查结果、视觉模拟评分（VAS）和手术时间来评估结果。使用 Cochrane Review Manager Software 5.4 进行统计分析。
本荟萃分析共纳入 10 项涉及 755 例患者的试验。结果表明，与切开复位内固定（ORIF）相比，ARIF 治疗踝关节骨折在功能结果和 VAS 评分方面更具优势。ARIF 和 ORIF 组之间术后并发症发生率和手术时间无显著差异。踝关节镜检查发现，踝关节骨折患者存在较高的软骨或骨软骨损伤（OCL）、韧带损伤和游离体发生率。
ARIF 治疗踝关节骨折可能优于 ORIF，可提供更好的功能结果和 VAS 评分。骨科医生在治疗急性踝关节骨折时应考虑到 OCL 和韧带损伤的高发生率。我们相信，随着手术经验的增加，术后并发症的发生和手术时间的延长将不再是外科医生的潜在关注点。
