创伤性踝关节炎置换与融合疗效的荟萃分析

Total ankle arthroplasty versus ankle arthrodesis for traumatic ankle arthritis: A meta analysis

摘要:

[目的] 对踝关节置换术 （total ankle arthroplasty, TAA） 与踝关节融合术 （ankle arthrodesis, AA） 治疗创伤性踝关节炎的疗效性进行系统性分析。[方法]计算机检索 PubMed、Cochrane Library、Embase、中国知网（CNKI）、维普和万方数据库自建库至 2022 年 10 月有关国内外 TAA 与 AA 治疗创伤性踝关节炎的中、英文文献。筛选符合纳入标准的文献后评价偏倚风险，提取相关数据使用 RevMan5.3 软件进行荟萃分析。[结果]本研究共纳入 8 篇文献，4 篇回顾性队列研究，4 篇随机对照试验，共计 481 例病例，其中 TAA 组患者 253 人，AA 组患者 228 人。荟萃分析表明：TAA 组手术时间显著低于 AA 组 （MD=- 51.88，95%CI -98.18~-5.58，P=0.03），TAA 组 Kofoed 评分显著高于 AA 组（MD=6.60，95%CI 3.72~9.47，P＜0.01），TAA 组术后跛行情况显著轻于 AA 组 （MD=0.17，95%CI 0.05~0.55，P＜0.01），但 TAA 术后翻修次数显著多于 AA 组 （MD=2.73，95% CI：1.05~7.14，P=0.04）。而两组 AOFAS 评分（MD=3.47，95%CI -2.90~9.84，P=0.29）、VAS 评分（MD=-0.90，95%CI -1.95~ 0.15，P=0.09）、术后并发症 （MD=3.77，95%CI 0.42~33.93，P=0.24） 和术中出血量 （MD=49.21，95%CI -9.04~107.46，P= 0.10）的差异上无统计学意义。[结论]与 AA 相比，TAA 具有术后感受更好，踝关节功能恢复快等优势，但是术后翻修次数明显增多。

Abstract:

[Objective] To systematically compare the clinical outcomes of total ankle arthroplasty (TAA) versus ankle arthrodesis (AA) in the treatment of traumatic ankle arthritis. [Methods] The articles in Chinese and English on TAA and AA for traumatic ankle arthritis at home and abroad were searched in databases, including PubMed, Cochrane Library, Embase, CNKI, VIP and Wanfang, from creating to Oc- tober 2022. After the papers were selected by screening to meet the inclusion criteria and bias risk evaluation, data were extracted for a me- ta-analysis using RevMan5.3 software. [Results] A total of 8 articles were included in this study, including 4 retrospective cohort studies and 4 randomized controlled trials with a total of 481 cases, 253 in the TAA group and 228 in the AA group. As results of meta-analysis, the TAA group consumed significantly shorter operation time than the AA group (MD=-51.88, 95%CI -98.18~-5.58, P=0.03), the former had significantly higher Kofoed score than the latter (MD=6.60, 95%CI 3.72~9.47, P＜0.01), the TAA group proved significantly less postop- erative claudication than the AA group (MD=0.17, 95%CI 0.05~0.55, P＜0.01), whereas the TAA group got significantly more number of postoperative revisions than the AA group (MD=2.73, 95%CI 1.05~7.14, P=0.04). However, there were no significant differences between the two groups in terms of AOFAS score (MD=3.47, 95%CI -2.90~9.84, P=0.29), VAS score (MD=-0.90, 95%CI -1.95~0.15, P=0.09), postoperative complications (MD=3.77, 95%CI -0.42~33.93, P=0.24) and intraoperative blood loss (MD=49.21, 95%CI -9.04~107.46, P= 0.10). [Conclusion] Compared with the AA group, the TAA group has the advantages of better postoperative feeling and faster functional re- covery of ankle joint, but has significantly increased risk of postoperative revision.