Tianyou Hospital affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, 430064, China.
Syst Rev. 2024 Feb 2;13(1):51. doi: 10.1186/s13643-023-02448-2.
The objective of this study was to conduct a meta-analysis by synthesizing multiple literature sources to explore whether there are any differences between elastic fixation and rigid fixation in the treatment of acute tibiofibular syndesmosis injuries. The aim was to provide effective guidance for clinical treatment.
We conducted a comprehensive search across seven databases, including both Chinese and English, to include all studies related to the treatment of acute tibiofibular syndesmosis injuries with elastic fixation and rigid fixation published between January 1, 2013, and November 15, 2022. Following the PRISMA guidelines, we rigorously screened, assessed, and extracted data from the included studies. The outcome measures included AOFAS scores at 3, 6, and 12 months postoperatively; tibiofibular clear space (TBCS) and tibiofibular overlap distance (TBOL) at the early postoperative and 12-month follow-up; intraoperative blood loss; operative time; time to full weight-bearing postoperatively; and postoperative complications. Meta-analysis was performed using Review Manager 5.4.
A total of 35 studies were included, comprising 16 randomized controlled trials and 19 retrospective cohort studies. The study population included 2120 cases, with 1044 cases in the elastic fixation group and 1076 cases in the rigid fixation group. The elastic fixation group had higher AOFAS scores at 3, 6, and 12 months postoperatively compared to the rigid fixation group. Although the elastic fixation group had a slightly larger TBCS than the rigid fixation group in the early postoperative period, the difference between the two groups became statistically insignificant at 12 months postoperatively. There was no statistically significant difference in TBOL between the two groups in the early postoperative period, but at 12 months, the elastic fixation group had a greater TBOL than the rigid fixation group. Additionally, the elastic fixation group had lower rates of postoperative local irritation, wound infection, and postoperative internal fixation loosening or rupture compared to the rigid fixation group. The rate of postoperative tibiofibular redislocation did not differ statistically between the two groups. The time to full weight-bearing was shorter in the elastic fixation group than in the rigid fixation group. Although the elastic fixation group had a slightly longer operative time, there was no statistically significant difference in intraoperative blood loss between the two groups.
Compared to rigid fixation, elastic fixation in the treatment of acute tibiofibular syndesmosis injuries offers several advantages, including better postoperative ankle joint function recovery, more precise anatomical reduction of the syndesmosis postoperatively, a lower incidence of postoperative complications, and shorter time to full weight-bearing postoperatively. These findings provide robust guidance for clinical treatment.
本研究旨在通过综合多个文献来源进行荟萃分析，探讨急性胫腓联合损伤的弹性固定与刚性固定治疗之间是否存在差异。旨在为临床治疗提供有效指导。
我们在包括中文和英文在内的七个数据库中进行了全面检索，纳入了 2013 年 1 月 1 日至 2022 年 11 月 15 日期间发表的关于急性胫腓联合损伤弹性固定和刚性固定治疗的所有研究。我们严格按照 PRISMA 指南筛选、评估和提取纳入研究的数据。主要结局指标包括术后 3、6 和 12 个月的 AOFAS 评分；术后早期和 12 个月随访时的胫腓骨间隙（TBCS）和胫腓骨重叠距离（TBOL）；术中出血量；手术时间；术后完全负重时间；以及术后并发症。使用 Review Manager 5.4 进行荟萃分析。
共纳入 35 项研究，包括 16 项随机对照试验和 19 项回顾性队列研究。研究人群包括 2120 例患者，其中弹性固定组 1044 例，刚性固定组 1076 例。与刚性固定组相比，弹性固定组术后 3、6 和 12 个月的 AOFAS 评分更高。虽然弹性固定组在术后早期的 TBCS 略大于刚性固定组，但在术后 12 个月时两组间的差异无统计学意义。两组在术后早期的 TBOL 无统计学差异，但在 12 个月时，弹性固定组的 TBOL 大于刚性固定组。此外，与刚性固定组相比，弹性固定组术后局部刺激、伤口感染和术后内固定松动或断裂的发生率较低。两组术后胫腓骨再脱位的发生率无统计学差异。弹性固定组完全负重时间短于刚性固定组。虽然弹性固定组的手术时间略长，但两组术中出血量无统计学差异。
与刚性固定相比，弹性固定治疗急性胫腓联合损伤具有以下优势：术后踝关节功能恢复更好、术后胫腓联合解剖复位更精确、术后并发症发生率更低、术后完全负重时间更早。这些发现为临床治疗提供了有力的指导。
