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手术与非手术治疗孤立性 Weber B 型踝关节骨折的比较：系统评价和荟萃分析。

Comparison of operatively and nonoperatively treated isolated Weber B ankle fractures: a systematic review and meta-analysis.

机构信息

Department of Orthopedic Surgery, Handan Central Hospital, 15 South Zhonghua Street, Handan, Hebei, 056008, China.

出版信息

J Orthop Surg Res. 2024 Jun 10;19(1):346. doi: 10.1186/s13018-024-04835-4.

DOI:10.1186/s13018-024-04835-4
PMID:38858737
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11163742/
Abstract

BACKGROUND

Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures.

METHODS

This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate.

RESULT

Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I = 67%).

摘要

背景

尽管孤立性 Weber B 型骨折较为常见，但对于手术与保守治疗的相对疗效仍缺乏明确认识。本系统评价和荟萃分析旨在探讨手术与保守治疗孤立性 Weber B 型踝关节骨折的临床效果和并发症。

方法

本研究通过对多个电子数据库（包括 PubMed、Cochrane、Embase 和 Web of Science）进行全面检索，以确定所有关于手术与保守治疗孤立性 Weber B 型踝关节骨折的相关文献。通过综合荟萃分析，评估了术后功能、并发症和再次手术率等多个结局。

结果

共纳入 6 项研究，涉及 818 例符合纳入标准的患者。其中，350 例为男性，636 例为女性。651 例患者接受保守治疗，396 例患者接受手术治疗。研究结果表明，孤立性 Weber B 型踝关节骨折患者接受手术与非手术治疗后，在 OMAS、FAOQ、PCS、MCS 评分和重返工作方面无显著差异。然而，与手术治疗相比，非手术治疗具有更高的 AOFAS 评分（MD = -5.31，95%CI = [-9.06，-1.55]，P=0.20，I²=39%）、更低的 VAS 评分（MD = 0.72，95%CI = [0.33，1.10]，P=0.69，I²=0%）、更低的并发症发生率（RR = 3.06，95%CI = [1.58，6.01]，P=0.05，I²=54%）和更低的再次手术率（RR = 8.40，95%CI = [1.57，45.06]，P=0.05，I²=67%）。

结论

孤立性 Weber B 型踝关节骨折的手术与保守治疗在功能恢复方面无显著差异，但保守治疗在缓解疼痛、降低并发症发生率和再次手术率方面具有一定优势。

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