Lisfranc损伤的一期关节融合术或切开复位内固定术：随机对照试验的系统评价和荟萃分析
Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
作者信息
Mactier Lachlan, Cox Genevieve, Mittal Rajat, Suthersan Mayuran
机构信息
University of Notre Dame Australia Rural Clinical School of Medicine, Darlinghurst, NSW, Australia.
Orthopaedic Department, Liverpool Hospital, Sydney, NSW, Australia.
出版信息
Foot Ankle Orthop. 2024 Oct 18;9(4):24730114241286892. doi: 10.1177/24730114241286892. eCollection 2024 Oct.
BACKGROUND
Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries.
METHODS
This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF.
RESULTS
Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery.
CONCLUSION
This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to "fix or fuse" for Lisfranc injuries.
背景
Lisfranc损伤通常采用一期关节融合术（PA）或切开复位内固定术（ORIF）进行手术治疗；然而，尚无证据表明哪种方法更具优势。本系统评价和荟萃分析评估了随机对照试验（RCT），以比较PA和ORIF治疗Lisfranc损伤的功能和手术结果。
方法
本研究按照PRISMA方案进行。在Cochrane、Embase和PubMed数据库中进行检索。共纳入5项RCT，涉及241例患者，其中121例行PA，120例行ORIF。
结果
观察到2年时视觉模拟量表疼痛评分（平均差值0.89，95%CI 0.18 - 1.59）、患者满意度（OR 10.04，95%CI 1.78 - 56.76）和全因再次手术率（OR 27.31，95%CI 12.72 - 58.63）存在统计学显著差异，均支持PA。在2年时美国足踝外科协会中足评分、36项简明健康调查问卷（SF - 36）评分以及非计划再次手术方面，PA和ORIF之间无统计学显著差异。
结论
本研究表明，在所有情况下，2年时疼痛、患者满意度以及全因再次手术率均有显著改善，支持PA。鉴于ORIF通常需要二次手术取出内固定物，预计ORIF组的全因再次手术率会更高。总体而言，由于显著的异质性，这些结果无法表明某一特定方法具有优势。进一步的研究应聚焦于更大的患者队列和更长的随访时间，或按患者人口统计学特征和损伤表现进行分层分析。在无临床显著差异的情况下，应考虑进行成本效益分析，以回答Lisfranc损伤应“固定还是融合”的问题。
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