应用闭合撬拨复位固定术与切开复位固定术治疗闭合性移位型跟骨关节内骨折临床疗效的Meta分析

摘要

目的：探讨应用经皮撬拨复位固定术与切开复位固定术治疗闭合性移位型跟骨关节内骨折的临床疗效差异。方法利用Cochrane数据库、Pubmed数据库、CNKI中国期刊全文数据库及中国生物医学文献数据库、万方数据库，并辅以手工检索、文献追溯相关文献，收集2005年1月至2015年8月国内外正式刊物上公开发表的有关经皮撬拨复位固定术与切开复位固定术治疗移位型跟骨关节内骨折对照研究的中英文文献，严格评价纳入研究的文献质量及提取相关资料，运用RevMan5.0软件统计分析所有相关数据。结果共纳入12项病例对照研究，共796例患者。分析结果提示对于移位型跟骨关节内骨折，与切开复位固定治疗相比，经皮撬拨复位固定治疗组术后并发症发生率较低[相对危险度（RR）=0.30，95％可信区间（CI）（0.17，0.53），P＜0.05]，而在跟骨术后Bohle角恢复角度[加权均数差（WMD）=－2.17，95％CI（－4.50，0.17），P＞0.05]，跟骨术后Gissane角恢复角度[WMD=－3.51，95％CI（－7.27，0.26），P＞0.05]，术后患足Maryland功能评分优良率[RR=0.94，95％CI（0.88，1.00），P＞0.05]等方面差异均无统计学意义。结论对于闭合性移位型跟骨关节内骨折，应用撬拨复位固定术治疗该疾患在术后并发症发生率方面低于切开复位固定治疗组，而在跟骨术后Bohler角恢复角度、跟骨术后Gis－sane角恢复角度、术后患足Maryland功能评分优良率等方面差异无统计学意义，2种手术方法都能得出较满意的临床效果。%Objective To evaluate the clinical efficacy of percutaneous poking vs open reduction for treatment of closed displaced intra-articular calcaneal fractures. Methods The Cochrane Library, Pubmed, CNKI, Chinese Biomedical Literature and Wanfang databaseswere searched, with additional manual retrievals, for related Chinese and international articles published between January 2005 and August 2015 comparing percutaneous poking reductionand open reduction for treatment of displaced intra-articular calcaneal fracture. The quality of studies and data extraction were rigorously evaluated. Statistical software RevMan5.0 was used to analyze all relevant data. Results A total of 12 case-control studies involving 796 patients were included in this meta-analysis. Our analysis suggested that percuta-neous poking reduction was associated with lower incidence of postoperative complications compared with open reduc-tion indisplaced calcaneal fractures [RR=0.30, 95%CI (0.17, 0.53), P0.05], Gis-sane angle [WMD=-3.51, 95% CI (-7.27, 0.26), P>0.05], and excellence rate of postoperative Maryland score of the affected feet [RR=0.94, 95% CI (0.88, 1.00), P>0.05]. Conclusion For closed displaced intra-articular calcaneal fractures, percutaneous poking reduction may result in lower postoperative complication rates compared with open re-duction. However, the postoperative recovery of Bohler angle, Gissane angle and excellence rate of postoperative Maryland score of the affected feetare clinically satisfactory that do not differ between the two treatment options.