可吸收螺钉与普通皮质骨螺钉治疗下胫腓联合损伤疗效的Meta分析

Meta-analysis of the curative effect by absorbable screw versus metallic screw treat syndesmotic injury

摘要:

目的利用Meta分析的方法综合评价生物可吸收螺钉与普通皮质骨螺钉在下胫腓联合损伤的手术治疗的疗效评价。方法通过查找万方数据库、维普数据库、Pubmed及Embase等数据库，共纳入12篇相关文献。采集踝关节功能优良率、踝关节功能评分、踝关节活动度及相关并发症等相关结果数据，利用RevMan5.35 对结果进行Meta分析。结果纳入的12 篇相关文献均为随机对照试验，共872 例患者，其中生物可吸收螺钉组（AS）447 例及普通皮质螺钉组（MS）425 例。Meta分析结果显示，与普通皮质骨螺钉相比，生物可吸收螺钉固定术后踝关节功能优良率更高，差异有统计学意义（p <0.05）；踝关节功能评分两组比较，差异无统计学意义（p >0.05）；踝关节背屈及跖屈活动度差异无统计学意义；生物可吸收螺钉固定术后并发症的发生率更高，其中异物反应发生率较普通皮质骨螺钉组高，其余如断钉、异位骨化、感染及创伤性关节炎等并发症发生率与普通皮质骨螺钉组差异无统计学意义。结论生物可吸收螺钉是治疗下胫腓损伤的有效内固定物，可有效避免普通皮质骨螺钉二次手术，同时也能减少断钉的风险及手术后感染发生的风险，但同时也增加异物反应发生率。

Abstract:

To comprehensive evaluate the curative effect of absorbable screw versus metallic screw in treatment of syndesmotic injury by meta analysis. Methods Through searching wanfang database, VIP database, pubmed, embase database, 12 literatures were included. The ankle joint function rate, ankle function score, ankle joint mobility and related complications were collected, and the results were analyzed by Meta using RevMan 5.35. Results A total of 12 literatures were randomized controlled trials, including 872 cases,of which 447 cases of absorbable screw group (AS) and 425 cases of metallic screw group (MS). The results of meta analysis showed that, compared with metallic screw, the excellent and good rate of ankle joint function by absorbable screw fixation was higher, and there were significant differences (p < 0.05). Ankle function score was no significant difference between the two groups (p > 0.05). Ankle dorsiflexion and plantar-flexion had no significant difference. The postoperative complications of absorbable screw fixation had higher incidence, which was foreign body reaction incidence higher than metallic screw group. Broken nails, heterotopic ossification,infection, traumatic arthritis and et al complications had no significant difference with metallic screw group. Conclusions The absorbable screw is an effective internal fixation for the treatment of syndesmoticinjury. It can effectively avoid the second operation by metallic screw, and also can reduce the risk of infection andthe risk of broken nails after operation, but also increase the incidence of foreign body reaction.