摘要
目的系统评价目前主要慢性跟腱断裂手术方式的有效性及安全性。方法对主要数据库PubMed、Embase、The Cochrane Library、中国知网(CNKI)及万方数据库进行系统检索,按纳入和排除标准筛选文献,提取资料,数据采用Q统计量进行异质性分析,Stata软件进行Meta分析。结果V-Y延长术、拇长屈肌腱转位术(FHLT)、腓肠肌筋膜瓣翻转术、半腱肌转位术、FHLT+腓肠肌筋膜瓣翻转术和FHLT+V-Y延长术中,美国矫形外科足踝协会(AOFAS)功能评分手术前后的均数差别为26.43(95%CI:17.26~35.60)分、32.63(95%CI:25.54~39.71)分、41.09(95%CI:10.57~71.61)分、22.00(95%CI:18.33~25.67)分、38.50(95%CI:28.38~44.63)分和38.58(95%CI:33.14~44.02)分,在运动恢复比例上分别为0.90(95%CI:0.76~1.03)分、0.93(95%CI:0.88~0.97)分、0.97(95%CI:0.92~1.02)分、0.96(95%CI:0.89~1.04)分、0.89(95%CI:0.81~0.98)分和0.94(95%CI:0.88~1.00)分,在并发症方面分别为0.13(95%CI:0~0.26)分、0.02(95%CI:0~0.05)分、0.09(95%CI:0~0.22)分、0.14(95%CI:0~0.33)分、0.09(95%CI:0.02~0.17)分和0.11(95%CI:0.01~0.21)分。上述术式合并的跟腱最大和平均缺损长度为8.93(95%CI:8.22~9.64)cm、5.83(95%CI:5.36~6.31)cm。结论慢性跟腱断裂目前采用的主要术式都能使患者取得较好的疗效,并发症较低。
Objective To systematically review the effectiveness and safety of major surgical methods for chronic Achilles tendon rupture.Methods The databases including PubMed,Embase,China National Knowledge Infrastructure(CNKI)were systematically searched and selected according to the inclusion criteria and exclusion criteria.The heterogeneity of the data was analyzed by Q statistics.The Meta-analysis was conducted by Stata software.Results About the American Orthopaedic Foot&Ankle Society(AOFAS)function score among V-Y,flexor hallucis longus transfer(FHLT),turndown flap,semitendinosus transfer,FHLT+turndown flap and FHLT+V-Y,the mean differences before and after treatment were 26.43(95%CI:17.26-35.60),32.63(95%CI:25.54-39.71),41.09(95%CI:10.57-71.61),22.00(95%CI:18.33-25.67),38.50(95%CI:28.38-44.63)and 38.58(95%CI:33.14-44.02).About the proportion of restoring to pre-injury sport level,V-Y,FHLT,turndown flap,semitendinosus transfer,FHLT+turndown flap and FHLT+V-Y were respectively 0.90(95%CI:0.76-1.03),0.93(95%CI:0.88-0.97),0.97(95%CI:0.92-1.02),0.96(95%CI:0.89-1.04),0.89(95%CI:0.81-0.98)and 0.94(95%CI:0.88-1.00).About the percentage of postoperative complications,V-Y,FHLT,turndown flap,semitendinosus transfer,FHLT+turndown flap and FHLT+V-Y were respectively 0.13(95%CI:0-0.26),0.02(95%CI:0-0.05),0.09(95%CI:0-0.22),0.14(95%CI:0-0.33),0.09(95%CI:0.02-0.17)and 0.11(95%CI:0.01-0.21).The maximum and average Achilles tendon defect length of the above surgical methods were 8.93 cm(95%CI:8.22-9.64 cm)and 5.83 cm(95%CI:5.36-6.31 cm).Conclusion The major surgical methods used for chronic Achilles tendon rupture currently can enable patients to obtain better curative effect and low complication rate.
作者
林杨景
杨柳
段小军
LIN Yangjing;YANG Liu;DUAN Xiaojun(Joint Surgery,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China)
出处
《重庆医学》
CAS
2020年第4期619-625,共7页
Chongqing medicine
关键词
慢性病
跟腱
跟腱断裂
系统评价
META分析
chronic disease
achilles tendon
achilles tendon rupture
systemassessment
Meta-analysis
作者简介
林杨景(1983-),主治医师,博士,主要从事关节外科及运动医学工作;通信作者:段小军,E-mail:dxj9@163.com。
