中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2013年
4期
370-376
,共7页
陈刚%李兵兵%任鹏%陈封明
陳剛%李兵兵%任鵬%陳封明
진강%리병병%임붕%진봉명
关节炎,类风湿%跖趾关节%关节融合%关节成形术%Meta分析
關節炎,類風濕%蹠趾關節%關節融閤%關節成形術%Meta分析
관절염,류풍습%척지관절%관절융합%관절성형술%Meta분석
Arthritis,rheumatoid%Metatarsophalangeal joint%Arthrodesis%Arthroplasty%Meta-analysis
目的 比较第一跖趾关节融合术与成形术治疗类风湿前足畸形的临床疗效.方法 计算机检索PubMed(1990年1月至2012年6月)、CNKI(1990年1月至2012年6月)、OVID(1996年1月至2012年6月)、中国生物医学文献光盘数据库、EMBASE(1966年1月至2012年6月)、万方数据库(1990年1月至2012年6月)和Cochrane Library(2011年第3期),搜集第一跖趾关节融合术与关节成形术比较治疗类风湿前足畸形的随机对照研究,对纳入的文献选择患者满意度、(足母)趾区负重、AOFAS穿鞋评分、外观评分、足功能指数评分、(足母)外翻角、第一、二跖骨间角、手术时间、并发症作为系统评价的指标.采用RevMan 5.1进行分析.结果 共纳入5项研究,285例患者.Meta分析显示:第一跖趾关节融合术的AOFAS穿鞋评分、外观评分优于第一跖趾关节成形术[MD=-0.88,95％CI(-1.55,-0.22),P=0.010;MD=-5.04,95％CI(-8.94,-1.14),P=0.01],矫正第一、二跖骨间角、(足母)外翻角的能力较成形组好[MD=1.43,95％CI (0.37,2.48),P=0.008；MD=13.27,95％CI (11.44,15.09),P＜ 0.00001]、并发症少[OR=2.32,95％CI(1.06,5.05),P=0.03].而患者满意度、足功能指数评分,两组疗效相当.结论 第一跖趾关节融合术联合二至五趾跖骨头切除成形术治疗类风湿前足畸形,可有效缓解疼痛、改善足的外观及功能、术后并发症少,其疗效优于第一跖趾关节成形术.
目的 比較第一蹠趾關節融閤術與成形術治療類風濕前足畸形的臨床療效.方法 計算機檢索PubMed(1990年1月至2012年6月)、CNKI(1990年1月至2012年6月)、OVID(1996年1月至2012年6月)、中國生物醫學文獻光盤數據庫、EMBASE(1966年1月至2012年6月)、萬方數據庫(1990年1月至2012年6月)和Cochrane Library(2011年第3期),搜集第一蹠趾關節融閤術與關節成形術比較治療類風濕前足畸形的隨機對照研究,對納入的文獻選擇患者滿意度、(足母)趾區負重、AOFAS穿鞋評分、外觀評分、足功能指數評分、(足母)外翻角、第一、二蹠骨間角、手術時間、併髮癥作為繫統評價的指標.採用RevMan 5.1進行分析.結果 共納入5項研究,285例患者.Meta分析顯示:第一蹠趾關節融閤術的AOFAS穿鞋評分、外觀評分優于第一蹠趾關節成形術[MD=-0.88,95％CI(-1.55,-0.22),P=0.010;MD=-5.04,95％CI(-8.94,-1.14),P=0.01],矯正第一、二蹠骨間角、(足母)外翻角的能力較成形組好[MD=1.43,95％CI (0.37,2.48),P=0.008；MD=13.27,95％CI (11.44,15.09),P＜ 0.00001]、併髮癥少[OR=2.32,95％CI(1.06,5.05),P=0.03].而患者滿意度、足功能指數評分,兩組療效相噹.結論 第一蹠趾關節融閤術聯閤二至五趾蹠骨頭切除成形術治療類風濕前足畸形,可有效緩解疼痛、改善足的外觀及功能、術後併髮癥少,其療效優于第一蹠趾關節成形術.
목적 비교제일척지관절융합술여성형술치료류풍습전족기형적림상료효.방법 계산궤검색PubMed(1990년1월지2012년6월)、CNKI(1990년1월지2012년6월)、OVID(1996년1월지2012년6월)、중국생물의학문헌광반수거고、EMBASE(1966년1월지2012년6월)、만방수거고(1990년1월지2012년6월)화Cochrane Library(2011년제3기),수집제일척지관절융합술여관절성형술비교치료류풍습전족기형적수궤대조연구,대납입적문헌선택환자만의도、(족모)지구부중、AOFAS천혜평분、외관평분、족공능지수평분、(족모)외번각、제일、이척골간각、수술시간、병발증작위계통평개적지표.채용RevMan 5.1진행분석.결과 공납입5항연구,285례환자.Meta분석현시:제일척지관절융합술적AOFAS천혜평분、외관평분우우제일척지관절성형술[MD=-0.88,95％CI(-1.55,-0.22),P=0.010;MD=-5.04,95％CI(-8.94,-1.14),P=0.01],교정제일、이척골간각、(족모)외번각적능력교성형조호[MD=1.43,95％CI (0.37,2.48),P=0.008；MD=13.27,95％CI (11.44,15.09),P＜ 0.00001]、병발증소[OR=2.32,95％CI(1.06,5.05),P=0.03].이환자만의도、족공능지수평분,량조료효상당.결론 제일척지관절융합술연합이지오지척골두절제성형술치료류풍습전족기형,가유효완해동통、개선족적외관급공능、술후병발증소,기료효우우제일척지관절성형술.
Objective To evaluate the efficacy of the first metatarsophalangeal joint arthrodesis versus resection arthroplasty for rheumatoid forefoot deformity.Methods Randomized controlled studies in the first metatarsophalangeal joint arthrodesis versus resection arthroplasty for rheumatoid forefoot deformity were collected in data bases like Cochrane library (Issue 3,2011),OVID (from January 1996 to June 2012),PubMed (from January 1990 to June 2012),CNKI (from January 1990 to June 2012),CBM,EMBASE (from January 1966 to June 2012) and Wanfang (from January 1990 to June 2012).Software RevMan 5.1 was used to analyze the trials included in terms of patient satisfaction,hallux area weight-bearing,AOFAS score,FFI score,HAV angle,IMA angle,operative time and complications.Results The totals of 5 RCTs were included in the study which involved 285 patients.The results of meta-analysis showed that the efficacy of the arthrodesis group was superior to that of the arthroplasty group in footwear (MD=-0.88,95％CI [-1.55,-0.22],P=0.010)and alignment (MD=-5.04,95％CI [-8.94,-1.14],P=0.01) significantly.The arthrodesis group also has an advantage of IMA and HAV angle correction (MD=1.43,95％CI [0.37,2.48],P=0.008; MD=13.27,95％CI [11.44,15.09],P＜ 0.00001).Significant difference was found between the two groups in the rate of complications.The rate of complication in the arthrodesis group was lower than that of the arthroplasty group (OR=2.32,95％CI [1.06,5.05],P=0.03).No significant difference was found between the two groups in patient satisfaction and FFI score.Conclusion Compared with resection arthroplasty,first metatarsophalangeal joint arthrodesis could be a better choice.It alleviates the pain effectively,improves the appearance and functions of the foot,and has a lower rate of postoperative complications.
