摘要
目的 系统评价微创内固定与切开复位治疗跟骨骨折的安全性与疗效.方法 计算机检索Cochrane图书馆、Medline数据库、中国知网、万方数据库、中国生物医学文献数据库、PubMed和Ovid等数据库,以及所有关于微创内固定与切开复位治疗跟骨骨折的临床对照试验.比较两组患者术后局部软组织情况、跟骨末次随访Bohler角及Gissane角.采用RevMan 4.2统计学软件进行Meta分析.结果 共纳入17篇文献（应用Jadad质量评分法评定文献质量：1篇文献为7分,2篇为4分,3篇为3分,11篇文献为2分）,包括1138例患者,其中微创内固定组569例,切开复位组569例.Meta分析结果显示：微创内固定组患者的术后切口局部软组织不良情况的发生少于切开复位组,差异有统计学意义[OR =0.26,95％ CI：（0.14,0.47）,P＜0.01].微创内固定组患者跟骨末次随访的Bohler角小于切开复位组[WMD=-1.29,95％ CI（-2.39,-0.19）,P=0.02].微创内固定组患者的跟骨末次随访的Gissane角与切开复位组比较差异无统计学意义[WMD=1.01,95％ CI：（-3.02,5.04）,P=0.62].结论 无论跟骨骨折的分型,微创内固定或者切开复位,两种方法术后Bohler角及Gissane角在跟骨力学特点恢复上是一样的.采用微创内固定,术后软组织愈合不良出现的概率要小于切开复位.
Objective To compare the safety and clinical outcome between minimally invasive internal fixation and open reduction in treatment of calcaneus fracture based on Meta analysis.Methods A computer-based online search of the Cochrane library,Medline database,CNKI,Wan Fang database,the Chinese biomedical literature database,PubMed,Ovid database and all was performed for clinical trials regarding minimally invasive internal fixation and open reduction in treatment of calcaneus fracture.Meta analysis was used to analyze the postoperative local soft tissue,calcaneal last follow-up Bohler angle and Gissane angle.Results A total of 17 studies were included（used Jadad quality grading,one is 7 points,two is 4 points,four is 3 points,ten is 2 points）,involving 1138 patients,including 569 patients used minimally invasive internal fixation and 569 used open reduction.Meta analysis showed that the incidence of postoperative local soft tissue poor healing used minimally invasive internal fixation is lower than used open reduction about,the difference was statistically significant [OR =0.26,95% CI：（0.14,0.47）,P 〈 0.01].Meta analysis showed that the calcaneal last follow-up Bohler angle of minimally invasive internal fixation was lower than open reduction,the difference was statistically significant [WMD =-1.29,95% CI：（-2.39,-0.19）,P =0.02].There were no statistically significant differences in the calcaneal last follow-up Bohler angle between minimally invasive internal fixation and open reduction[WMD =1.01,95%CI：（-3.02,5.04）,P =0.62].Conclusions Regardless of the calcaneal fracture type,minimally invasive internal fixation or open reduction,the postoperative Bohler angle and Gissane angle at the calcaneus mechanical recovery characteristics are the same.However,the postoperative soft tissue healing of minimally invasivc internal fixation is less better than open reduction.
出处
《国际外科学杂志》
2015年第8期512-516,F0003,共6页
International Journal of Surgery
基金
北京市自然科学基金资助项目（NO.7152061）
关键词
跟骨
骨折
手术治疗
微创内固定
切开复位
META分析
Calcaneus
Fracture,bone
Treatment,minimally invasive internal fixation
Open reduction
Meta-analysis
