Combined anterior and posterior vs isolated posterior facet fixation for subtalar arthrodesis: A proportional meta-analysis and systematic review of the literature.
Antonio Izzo, Giovanni Manzi, Martina D'Agostino, Massimo Mariconda, Shelain Patel, Alessio Bernasconi
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引用次数: 0
Abstract
Introduction: Subtalar arthrodesis (SA) is a common procedure to treat end-stage subtalar osteoarthritis. We set out in order to determine whether a combined direct fixation of both anterior and posterior facets during SA might influence union and complications compared to isolated fixation of the posterior facet. Our hypothesis was that a combined fixation increases the union rate and reduces the complication rate.
Methods: In this PRISMA-compliant PROSPERO-registered systematic review, we included studies reporting data after SA stabilized with screws in adults. The characteristics of the cohort, study design, surgical details, nonunion and complication rate at the longest follow-up were recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were compared: an ANT/POST group (screws positioned both in the anterior and posterior facet) and an ONLY POST group (isolated posterior facet fixation).
Results: Eighteen series (685 feet: ANT/POST = 96, ONLY POST = 589) were selected. The median follow-up was 28 months (IQR, 12-42). The pooled proportion showed a similar nonunion rate (6% vs 10%; p = 0.46) and complication rate (14% vs 19%, p = 0.47) in the ANT/POST group as compared to the ONLY POST group. The pooled proportion of reoperation was not different either (ANT/POST: 7% vs ONLY POST: 10%, p = 0.37). Kernel regression suggested a correlation between the proportion of open/arthroscopic procedures and the nonunion rate (p = 0.025) with a median nonunion rate at 10.9% and 5.9% for open and arthroscopic procedures, respectively. Mean CMS was 40.4 points (poor quality).
Conclusion: This proportional meta-analysis suggested that a combined direct fixation of anterior and posterior facets during subtalar arthrodesis does not significantly influence the risk of nonunion nor affects the risk of complication and reoperation as compared to isolated posterior facet fixation.
Level of evidence: IV; review of Level I-IV studies.
介绍：截骨关节置换术（SA）是治疗终末期截骨骨关节炎的常见手术。与单独固定后侧韧带相比，我们试图确定在SA术中对前侧和后侧韧带进行联合直接固定是否会影响关节的结合和并发症。我们的假设是，联合固定可提高结合率并降低并发症发生率：在这项符合 PRISMA 标准的 PROSPERO 注册系统性综述中，我们纳入了报告成人用螺钉稳定 SA 后数据的研究。我们记录了研究对象的特征、研究设计、手术细节、最长随访时间内的不愈合率和并发症发生率。采用改良科尔曼方法评分法（mCMS）评估研究质量。对两组研究进行了比较：ANT/POST 组（螺钉同时固定在前后关节面）和 ONLY POST 组（孤立的后关节面固定）：结果：共选取了 18 个系列（685 英尺：ANT/POST = 96，ONLY POST = 589）。中位随访时间为 28 个月（IQR，12-42）。汇总比例显示，ANT/POST组与ONLY POST组相比，非愈合率（6% vs 10%；P = 0.46）和并发症发生率（14% vs 19%；P = 0.47）相似。再次手术的总比例也没有差异（ANT/POST：7% vs ONLY POST：10%，p = 0.37）。核回归表明，开放/关节镜手术的比例与不愈合率之间存在相关性（p = 0.025），开放手术和关节镜手术的中位不愈合率分别为 10.9% 和 5.9%。平均CMS为40.4分（质量差）：该比例荟萃分析表明，与孤立的后关节面固定术相比，在距骨关节置换术中联合直接固定前关节面和后关节面不会显著影响骨不连的风险，也不会影响并发症和再次手术的风险：证据等级：IV；I-IV级研究综述。
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Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.
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