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拇僵硬切骨术的证据及患者预后回顾:一项系统评价与Meta分析

Reviewing Evidence and Patient Outcomes of Cheilectomy for Hallux Rigidus: A Systematic Review and Meta-Analysis.

作者信息

Arceri Alberto, Di Paola Gianmarco, Mazzotti Antonio, Zielli Simone Ottavio, Artioli Elena, Langone Laura, Sgubbi Federico, Faldini Cesare

机构信息

1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.

Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy.

出版信息

J Clin Med. 2024 Nov 30;13(23):7299. doi: 10.3390/jcm13237299.

Abstract

Cheilectomy is a joint-sparing surgery for the treatment of moderate stages of Hallux Rigidus (HR). The purpose of this systematic review was to assess the clinical outcomes, range of motion (ROM), complications, and revision rates associated with cheilectomy. A literature search of the PubMed, Scopus, and Cochrane databases was performed. PRISMA guidelines were used. Risk of bias was assessed through the Newcastle-Ottawa Scale. Meta-analysis of the clinical outcomes scores was performed. The initial search identified 317 articles, with 16 included. Cheilectomy improved ROM by 51.15% (41.23° to 62.32°), with greater gains in traditional (67.72%) vs. minimally invasive (48.74%) techniques. VAS decreased by 72.61%, more in traditional (79.35%) than minimally invasive (64.97%). AOFAS improved by 33.99%, from 61.83 to 82.85. Complications occurred in 11% (11.68% traditional, 9.73% minimally invasive), with residual pain (7.46%) more common in traditional and nerve injury (3.78%) in minimally invasive procedures. Revision rates were 7.4% overall (6.1% traditional, 8.8% minimally invasive). This procedure showed satisfactory results regardless of whether the traditional or minimally invasive technique is used. Current evidence does not allow for a definitive indication, but careful patient selection is advisable, particularly for mild to moderate cases.

摘要

关节切除术是一种保留关节的手术,用于治疗中度僵硬性拇趾(HR)。本系统评价的目的是评估与关节切除术相关的临床结果、活动范围(ROM)、并发症和翻修率。对PubMed、Scopus和Cochrane数据库进行了文献检索。使用了PRISMA指南。通过纽卡斯尔-渥太华量表评估偏倚风险。对临床结果评分进行了荟萃分析。初步检索确定了317篇文章,其中16篇被纳入。关节切除术使ROM提高了51.15%(从41.23°提高到62.32°),传统技术(67.72%)的改善幅度大于微创手术(48.74%)。视觉模拟评分(VAS)下降了72.61%,传统手术(79.35%)比微创手术(64.97%)下降更多。美国足踝外科协会(AOFAS)评分提高了33.99%,从61.83提高到82.85。并发症发生率为11%(传统手术为11.68%,微创手术为9.73%),传统手术中残留疼痛(7.46%)更常见,微创手术中神经损伤(3.78%)更常见。总体翻修率为7.4%(传统手术为6.1%,微创手术为8.8%)。无论采用传统技术还是微创手术,该手术均显示出满意的结果。目前的证据不允许明确的适应症,但建议仔细选择患者,特别是对于轻度至中度病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c5e/11642111/850459231d25/jcm-13-07299-g001.jpg

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