摘要
目的通过对已发表文献进行汇总分析，根据现有数据资料总结植骨与不植骨对切开复位内固定治疗跟骨关节内骨折预后的影响。方法通过系统检索1990年1月至2010年12月发表的关于切开复位内固定结合植骨（植骨组）或不植骨（不植骨组）治疗关节内跟骨骨折的英文文献。经全文阅读决定是否符合纳入标准或排除标准，收集相关结果和数据，通过循证医学分析方法，加权汇总分析2种治疗方案的功能预后和并发症。结果共32篇文献包含1281例患者纳入研究。植骨组与不植骨组的术后感染率、骨关节炎发生率、距下关节融合率比较差异无统计学意义（P〉0．05）。植骨组术足完全负重时间（平均5．4周）显著低于不植骨组（平均10．5周）。植骨组术后平均Bohler角显著大于不植骨组，且远期丢失较小。植骨组加权美国足踝外科协会（AOFAS）评分低于不植骨组，分别为71．4分和80．5分；但加权Creighton评分高于不植骨组，分别为89．9、81．0分。植骨组加权优良率：优35％，良40％，中21％，差4％，不植骨组：优34％，良42％，中14％，差10％，两组比较差异无统计学意义（P〉0．05）。结论切开复位内固定结合植骨治疗跟骨关节内骨折不会明显增加术后感染率，可较好地恢复Bohler角，患者可早期完全负重。但植骨组的纳入患者中，塌陷型和粉碎性骨折的比例较高，仍需配对设计的前瞻性比较研究进一步完善证据。
Objective To compare treatments of intra-articular calcaneal fractures with and without bone graft in foot and ankle surgery. Methods A comprehensive search was conducted on line for all English research articles published from January 1990 through December 2010 dealing with open reduction and internal fixation with and without bone graft for intra-articular calcaneal fractures. Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the 2 treatments. Results The systematic review identified 32 qualified primary studies with 1281 fractures. No significant differences were found in postop- erative infection, osteoarthritis or subtalar fusion between the 2 treatments （ P 〉 0. 05） . The average full weight-bearing time in bone graft treatment was significantly lower （5.4 weeks） than in non-graft treatment （10.5 weeks） . The mean Bohler angle was significantly larger and long-term loss of collapse significantly lower in bone graft treatment than in non-graft treatment. The bone graft treatment had a lower American Orthopaedic Foot and Ankle Society （AOFAS） score （71.4 points vs. 80.5 points） but a higher Creighton score （89.9 points vs. 81.0 points） compared with non-graft treatment. Pooled mean results showed no significant differences in the weighted excellent-to-good rate between the 2 treatments （excellent 35%, good 40%, fair 21% and poor 4% for the bone graft treatment versus excellent 34%, good 42%, fair 14%, and poor 10% for the non-graft treatment）. Conclusions Open reduction and internal fixation with bone graft for intra-articular calcaneal fractures may lead to better reduction of Bohler angle and early return to full weight-bearing without increased risk of postoperative infection. However, since more cases of joint depression and comminuted fracture have been included in the bone graft group in the present study, a prospective controlled comparative study with a large scale of samples is still needed.
出处
《中华创伤骨科杂志》
CAS
CSCD
2011年第8期725-729,共5页
Chinese Journal of Orthopaedic Trauma
关键词
跟骨
骨折
骨折固定术
内
Calcaneus
Fractures
Fracture fixation, internal
