Fiore P I, Soares S, Seidel A, Garibaldi R
EOC (Ente Ospedaliero Cantonale), Service of Orthopaedics and Traumatology, Lugano, Switzerland.
Eur Rev Med Pharmacol Sci. 2025 May;29(5):268-277. doi: 10.26355/eurrev_202505_37225.
OBJECTIVE: End-stage ankle arthritis is a debilitating condition for which ankle arthrodesis (AA) remains a principal surgical option. Open and arthroscopic techniques are widely used, yet the literature presents heterogeneous findings. This umbrella review consolidates systematic reviews and meta-analyses to compare open vs. arthroscopic ankle arthrodesis in terms of fusion rates, complications, and hospital stay duration. MATERIALS AND METHODS: Following a registered protocol (PROSPERO ID: CRD420246233349), we searched articles on PubMed, Embase, and the Cochrane Library from November 2 to November 10, 2024. We included systematic reviews and meta-analyses in English comparing open and arthroscopic AA, capturing data on fusion rates, postoperative complications (e.g., nonunion, infection), and hospital stay. Quality was assessed with AMSTAR 2. A descriptive synthesis was chosen due to methodological heterogeneity. RESULTS: Eight systematic reviews encompassing 74 primary studies (4,631 total procedures) met the inclusion criteria. Fusion rates were consistently high but higher with arthroscopic techniques (range 88.7-95.1%) compared to open methods (range 78.5-85.0%), with odds ratios frequently around 2.0-3.3 favoring arthroscopy. Complication rates (e.g., infection, wound problems) were significantly lower in arthroscopic groups, typically 6-10% vs. 13-18.5% in open groups, corresponding to odds ratios of approximately 0.47-0.60 in favor of arthroscopy. Additionally, hospital stays were shortened by an average of 1.2-1.8 days with arthroscopic approaches, reflecting a weighted mean difference often exceeding -1.60 days. These findings were attributed mainly to the minimally invasive nature of arthroscopy, which reduces soft tissue disruption and expedites recovery. CONCLUSIONS: Arthroscopic ankle arthrodesis demonstrates superior outcomes over open techniques, offering higher fusion rates, fewer complications, and shorter hospital stays. Although open approaches remain viable, particularly for complex deformities, these data underscore the procedural and systemic advantages of arthroscopy in most clinical scenarios. Further research should aim to refine indications, optimize arthroscopic protocols, and investigate patient-specific factors - such as smoking status and comorbidities - that may influence surgical outcomes.
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目的：终末期踝关节关节炎是一种使人衰弱的疾病，踝关节融合术（AA）仍是主要的手术选择。开放手术和关节镜技术被广泛应用，但文献报道的结果存在差异。本伞状综述整合了系统评价和荟萃分析，以比较开放手术与关节镜下踝关节融合术在融合率、并发症和住院时间方面的差异。材料与方法：按照注册方案（PROSPERO编号：CRD420246233349），我们于2024年11月2日至11月10日在PubMed、Embase和Cochrane图书馆检索文章。我们纳入了用英文比较开放手术与关节镜下AA的系统评价和荟萃分析，收集融合率、术后并发症（如不愈合、感染）和住院时间的数据。采用AMSTAR 2评估质量。由于方法学上的异质性，我们选择了描述性综合分析。结果：八项系统评价涵盖74项原始研究（共4631例手术）符合纳入标准。融合率一直很高，但关节镜技术的融合率（范围88.7%-95.1%）高于开放手术（范围78.5%-85.0%），优势比通常在2.0-3.3左右，有利于关节镜手术。关节镜组的并发症发生率（如感染、伤口问题）显著较低，通常为6%-10%，而开放组为13%-18.5%，相应的优势比约为0.47-0.60，有利于关节镜手术。此外，关节镜手术平均缩短住院时间1.2-1.8天，加权平均差通常超过-1.60天。这些结果主要归因于关节镜手术的微创性质，它减少了软组织损伤并加快了恢复。结论：关节镜下踝关节融合术的效果优于开放手术，融合率更高，并发症更少，住院时间更短。虽然开放手术仍然可行，特别是对于复杂畸形，但这些数据强调了关节镜手术在大多数临床情况下的手术和全身优势。进一步的研究应旨在完善适应症，优化关节镜手术方案，并研究可能影响手术结果的患者特定因素，如吸烟状况和合并症。
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