{"title":"后臼齿骨折前后螺钉固定与后外侧入路钢板固定的比较：系统综述与荟萃分析","authors":"","doi":"10.1016/j.fas.2024.05.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>There are two main surgical fixation methods for the posterior malleolar fractures<span> (PMFs), the anterior-to-posterior (AP) screws or via the posterolateral (PL) approach utilizing a buttress plate. This review aims to compare the clinical outcome between the AP screw fixation and the PL plate fixation for treating PMFs.</span></p></div><div><h3>Methods</h3><p>We searched all relevant publications about PMFs treated with AP screws or PL plates through electronic databases including the PubMed, the Cochrane Library, the Embase, the Wiley online library and the Web of Science. The meta-analysis was conducted to evaluated clinical outcomes including reduction quality, post-operative function and complications.</p></div><div><h3>Results</h3><p><span>Six studies (one single randomized controlled trial and five retrospective cohort studies) were enrolled. 172 patients underwent AP screw fixation and 214 patients underwent PL plate fixation with a total of 386 patients (169 males and 217 females). The PL plating group yielded better AOFAS scores(MD = 6.97, 95 % CI=[4.68, 9.27], </span><em>P</em>＜0.00001, I<sup>2</sup> =0 %) and was more likely to achieve excellent anatomical reduction(OR=5.49, 95 % CI=[1.06, 28.42], <em>P</em> = 0.04, I<sup>2</sup><span> =80 %). No differences were found in the bad reduction quality, incidences of complications (arthritis, neuralgia<span>, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees.</span></span></p></div><div><h3>Conclusion</h3><p>We suggest that the PL plate fixation method has the clinical benefit of achieving anatomical reduction and better AOFAS scores over the AP screw fixation for treating PMFs. No differences were found in the incidences of complications ( arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. The posterior approach and the direct reduction are recommended for the treatment of the PMFs.</p></div><div><h3>Level of Confidence</h3><p>Ⅱb</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 594-602"},"PeriodicalIF":1.9000,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison between anterior-to-posterior screw fixation versus posterolateral approach plate fixation for posterior malleous fracture: A systematic review and meta-analysis\",\"authors\":\"\",\"doi\":\"10.1016/j.fas.2024.05.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>There are two main surgical fixation methods for the posterior malleolar fractures<span> (PMFs), the anterior-to-posterior (AP) screws or via the posterolateral (PL) approach utilizing a buttress plate. This review aims to compare the clinical outcome between the AP screw fixation and the PL plate fixation for treating PMFs.</span></p></div><div><h3>Methods</h3><p>We searched all relevant publications about PMFs treated with AP screws or PL plates through electronic databases including the PubMed, the Cochrane Library, the Embase, the Wiley online library and the Web of Science. The meta-analysis was conducted to evaluated clinical outcomes including reduction quality, post-operative function and complications.</p></div><div><h3>Results</h3><p><span>Six studies (one single randomized controlled trial and five retrospective cohort studies) were enrolled. 172 patients underwent AP screw fixation and 214 patients underwent PL plate fixation with a total of 386 patients (169 males and 217 females). The PL plating group yielded better AOFAS scores(MD = 6.97, 95 % CI=[4.68, 9.27], </span><em>P</em>＜0.00001, I<sup>2</sup> =0 %) and was more likely to achieve excellent anatomical reduction(OR=5.49, 95 % CI=[1.06, 28.42], <em>P</em> = 0.04, I<sup>2</sup><span> =80 %). No differences were found in the bad reduction quality, incidences of complications (arthritis, neuralgia<span>, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees.</span></span></p></div><div><h3>Conclusion</h3><p>We suggest that the PL plate fixation method has the clinical benefit of achieving anatomical reduction and better AOFAS scores over the AP screw fixation for treating PMFs. No differences were found in the incidences of complications ( arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. The posterior approach and the direct reduction are recommended for the treatment of the PMFs.</p></div><div><h3>Level of Confidence</h3><p>Ⅱb</p></div>\",\"PeriodicalId\":48743,\"journal\":{\"name\":\"Foot and Ankle Surgery\",\"volume\":\"30 7\",\"pages\":\"Pages 594-602\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-05-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Foot and Ankle Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1268773124001061\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot and Ankle Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1268773124001061","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的耳后臼骨骨折（PMFs）主要有两种手术固定方法，一种是前对后（AP）螺钉固定，另一种是通过后外侧（PL）入路使用托板固定。本综述旨在比较AP螺钉固定和PL钢板固定治疗PMF的临床效果。方法我们通过电子数据库（包括PubMed、Cochrane图书馆、Embase、Wiley在线图书馆和Web of Science）检索了所有关于用AP螺钉或PL钢板治疗PMF的相关文献。结果六项研究（一项随机对照试验和五项回顾性队列研究）入选。172名患者接受了AP螺钉固定术，214名患者接受了PL钢板固定术，共计386名患者（男性169名，女性217名）。PL钢板固定组的AOFAS评分更高（MD=6.97，95 % CI=[4.68，9.27]，P＜0.00001，I2 =0%），更有可能获得最佳解剖复位（OR=5.49，95 % CI=[1.06，28.42]，P=0.04，I2 =80%）。结论我们认为，PL钢板固定法比AP螺钉固定法在治疗PMF时具有解剖复位和更好的AOFAS评分的临床优势。在并发症（关节炎、神经痛、表皮伤口愈合问题和植入失败）的发生率、行走 VAS 评分和背伸受限程度方面，均未发现差异。建议采用后路和直接还原法治疗 PMFs。
Comparison between anterior-to-posterior screw fixation versus posterolateral approach plate fixation for posterior malleous fracture: A systematic review and meta-analysis
Purpose
There are two main surgical fixation methods for the posterior malleolar fractures (PMFs), the anterior-to-posterior (AP) screws or via the posterolateral (PL) approach utilizing a buttress plate. This review aims to compare the clinical outcome between the AP screw fixation and the PL plate fixation for treating PMFs.
Methods
We searched all relevant publications about PMFs treated with AP screws or PL plates through electronic databases including the PubMed, the Cochrane Library, the Embase, the Wiley online library and the Web of Science. The meta-analysis was conducted to evaluated clinical outcomes including reduction quality, post-operative function and complications.
Results
Six studies (one single randomized controlled trial and five retrospective cohort studies) were enrolled. 172 patients underwent AP screw fixation and 214 patients underwent PL plate fixation with a total of 386 patients (169 males and 217 females). The PL plating group yielded better AOFAS scores(MD = 6.97, 95 % CI=[4.68, 9.27], P＜0.00001, I2 =0 %) and was more likely to achieve excellent anatomical reduction(OR=5.49, 95 % CI=[1.06, 28.42], P = 0.04, I2 =80 %). No differences were found in the bad reduction quality, incidences of complications (arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees.
Conclusion
We suggest that the PL plate fixation method has the clinical benefit of achieving anatomical reduction and better AOFAS scores over the AP screw fixation for treating PMFs. No differences were found in the incidences of complications ( arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. The posterior approach and the direct reduction are recommended for the treatment of the PMFs.
期刊介绍：
Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society.
The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.
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