摘要
目的:通过meta分析比较距下关节制动术(SA)与外侧柱延长术(LCL)治疗扁平足的临床疗效.方法:检索建库至2022年8月中国知网、维普、万方、Embase、PubMed、Web of Science、The Cochrane Library数据库关于SA与LCL治疗扁平足的相关文献.由两名作者根据纳入与排除标准进行文献筛选、数据提取,并对纳入文献进行质量评价.采用Review Maager 5.4软件对术后足部正位距骨第1跖骨角(T1MT)、足部侧位距骨第1跖骨角(Meary角)、距舟覆盖角(TCA)、跟骨倾斜角(Pitch角)、疼痛视觉模拟评分(VAS)、美国足踝外科(AOFAS)踝与后足功能评分、并发症发生率进行meta分析.结果:共纳入6篇文献,其中2篇为随机对照研究,4篇为队列研究.Meta分析结果显示:SA组与LCL组在T1MT、TCA、AOFAS踝与后足功能评分、疼痛VAS评分方面比较差异均无统计学意义(P均＞0.05),LCL组在矫正Pitch角结果上优于SA组(MD=-1.87,95％CI:-3.49～-0.25,P=0.02),LCL组的并发症发生率低于SA组(MD=2.17,95％CI:1.16～4.08,P=0.02).对于＜18岁的患者,SA组与LCL组在TCA、Pitch角、AOFAS踝与后足功能评分、疼痛VAS评分方面比较差异均无统计学意义(P均＞0.05),LCL组在矫正Meary角结果上优于SA组(MD=-0.79,95％CI:-1.57～-0.02,P=0.04),SA组与 LCL组的并发症发生率比较差异无统计学意义(MD=1.29,95％CI:0.64～2.69,P=0.50);对于≥18岁的患者,SA组的并发症发生率高于LCL组(MD=5.61,95％CI:1.49～21.13,P=0.01).结论:LCL和SA矫正扁平足畸形均可获得满意疗效,LCL相比SA治疗扁平足畸形较严重者可以取得更好的结果.不推荐SA用于成人扁平足的治疗,因为术后并发症发生率较高,LCL的应用则无明显年龄限制.扁平足的治疗应结合患者病情制定合理化、个性化的治疗方案.
Abstract
Objective:This meta-analysis aimed to compare the clinical efficacy of subtalar arthroereisis(SA)and lateral column lengthening(LCL)in the treatment of flat foot.Methods:Relevant literature on the treatment of flat foot with SA and LCL was systematically retrieved from databases including CNKI,VIP,Wanfang,Embase,PubMed,Web of Science,and The Cochrane Library up to August 2022.Two reviewers independently screened the literature,extracted data,and evaluated the quality of the included studies according to predetermined exclusion and inclusion criteria.Review Manager 5.4 software was utilized to perform meta-analyses on postoperative parameters including talar 1 metatarsal angle(T1MT),Meary angle,talonavicular coverage angle(TCA),pitch angle,pain visual analogue scale(VAS),American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot scores,and complication rate.Results:A total of 6 studies were included,comprising 2 randomized controlled trials and 4 cohort studies.The meta-analysis results indicated that there was no statistically significant difference between the SA group and LCL group in terms of T1MT,TCA,AOFAS scores,and pain VAS scores(all P＞0.05).Compared to the SA group,the LCL group exhibited superior correction of pitch angle(MD=-1.87,95％CI:-3.49--0.25,P=0.02)and lower complication rates(MD=2.17,95％CI:1.16-4.08,P=0.02).For patients under 18 years old,there were no statistically significant differences between the two groups in terms of TCA,pitch angle,AOFAS score,and pain VAS score(all P＞0.05).However,the correction of Meary angle was significantly greater in the LCL group(MD=-0.79,95％CI:-1.57--0.02,P=0.04)than in the SA group.There was no statistically significant difference between the two groups in terms of complication rates(MD=1.29,95％CI:0.64-2.69,P=0.50).For patients aged 18 and older,the complication rate in SA group was significantly higher than that in LCL group(MD=5.61,95％CI:1.49-21.13,P=0.01).Conclusions:Both LCL and SA are effective in the treatment of flatfoot deformity,with LCL showing better outcomes in severe cases.SA is not recommended for adult flatfoot treatment due to higher risk for postoperative complications,while LCL has no apparent age limitation.Therefore,treatment of flatfoot should be individualized based on patient conditions.
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