CAJ | 학술논문

目的：对国内外有关手术治疗与保守治疗移位型跟骨关节内骨折的的研究文献进行分析，评价它们临床疗效及安全性。方法计算机检索Cochrane图书馆、PudMed、Ovid、Elesive、CNKI等数据库。检索从（1969－06－04，2014－06－04）年有关手术治疗与保守治疗比较治疗移位型跟骨关节内骨折的随机对照试验（ RCTs），筛选出符合纳入标准的文献，并对其进行严格的质量评价。利用Cochrane协作网提供的RevMan 5.0软件对纳入研究结果进行Meta分析，并对数据进行异质性检验。结果共纳入9篇，手术组382例，保守组389例，Meta分析结果显示，与保守组比较，手术组穿鞋方式改变者的例数少（P＜0.05），总并发症发生率低（P＜0.05），不能恢复原工作者的例数少（P＜0.05），距下关节融合例数少（P＜0.05）；在B?hler角度变化程度上保守组与手术组比较中，手术组恢复的更好（ P＜0.05）。但在患肢足跟残痛发生的例数、AOFAS评分、距下关节运动范围＜50％发生的例数和跟骨恢复高度方面，两组的差异无统计学意义。结论综合考虑在恢复跟骨解剖结构，更好的康复效果及更少的并发症发生方面，手术治疗应是其最佳选择。
목적：대국내외유관수술치료여보수치료이위형근골관절내골절적적연구문헌진행분석，평개타문림상료효급안전성。방법계산궤검색Cochrane도서관、PudMed、Ovid、Elesive、CNKI등수거고。검색종（1969－06－04，2014－06－04）년유관수술치료여보수치료비교치료이위형근골관절내골절적수궤대조시험（ RCTs），사선출부합납입표준적문헌，병대기진행엄격적질량평개。이용Cochrane협작망제공적RevMan 5.0연건대납입연구결과진행Meta분석，병대수거진행이질성검험。결과공납입9편，수술조382례，보수조389례，Meta분석결과현시，여보수조비교，수술조천혜방식개변자적례수소（P＜0.05），총병발증발생솔저（P＜0.05），불능회복원공작자적례수소（P＜0.05），거하관절융합례수소（P＜0.05）；재B?hler각도변화정도상보수조여수술조비교중，수술조회복적경호（ P＜0.05）。단재환지족근잔통발생적례수、AOFAS평분、거하관절운동범위＜50％발생적례수화근골회복고도방면，량조적차이무통계학의의。결론종합고필재회복근골해부결구，경호적강복효과급경소적병발증발생방면，수술치료응시기최가선택。
Objective To analyze both the English and Chinese literatures of surgery versus nonsurgical treatment for displacement intra-articular calcaneal fractures ( DIACF ) , and to evaluate the clinical outcomes and safety.Methods Five electronic databases ( PudMed, Ovid, Elesive, Cochrane library and CNKI) were systematically searched to identify randomised controlled trials ( RCTs) in which surgical treatment was compared with nonsurgical treatment for DIACF from 1969/06/04 to 2014/06/04. The literatures′quality was strictly assessed.The analysis was performed with software RevMan5.0 from the Cochrane collaboration.The heterogeneity of data was also checked.Results Nine studies with a total of 771 participants were enrolled.The surgical group consisted of 382 patients, and the nonsurgical group consisted of 389 patients.The results showed that the surgical treatment was superior to nonsurgical treatment in the rate of complications ( P<0.05 ) , the case number of subtalar joint fusion ( P<0.05 ) , the problem in wearing shoes (P<0.05), the case number of resuming pre-injury work (P<0.05), and in the changes of B?hler angle ( P <0.001 ) .No significant difference was identified between the two methods regarding the rate of residual pain, American Orthopaedic Foot and Ankle Society ( AOFAS ) scores, cases with subtalar joint movement range <50%, and calcaneal height restoration.Conclusion According to this Meta-analysis, surgical treatment for DIACF may be superior to nonsurgical treatment in reconstruction of anatomical structures, social function recovery and reducing the complication incidence, which is the best choice.