目的:系统评价止血带在踝关节骨折切开复位内固定术中的应用价值。方法:应用计算机检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Cochrane Library、Web of Science和Embase中有关踝关节骨折切开复位内固定术中使用止血带的随机对照试验文献，检索时限均为建库至2024年4月。试验组术中使用止血带，对照组术中未使用止血带。采用Cochrane系统评价手册中的偏倚风险评估工具对纳入研究的文献进行质量评价，采用RevMan4。3软件进行Meta分析。结果:共检索到53篇文献，经筛选后最终纳入6篇文献，涉及1347例患者，其中试验组744例、对照组603例。Meta分析结果显示，试验组的手术时间短于对照组[MD=-6。80，95％CI(-12。14，-1。46)，P=0。013]，疼痛视觉模拟量表评分高于对照组[MD=1。01，95％CI(0。46，1。57)，P=0。000]，踝关节活动度小于对照组[MD=-5。25，95％CI(-9。61，-0。89)，P=0。018]，下肢深静脉血栓发生率高于对照组[RR=6。34，95％CI(1。45，27。79)，P=0。014]，2组住院时间、切口感染发生率、切口延迟愈合或不愈合发生率的组间差异均无统计学意义[MD=1。88，95％CI(-0。48，4。23)，P=0。118;RR=1。37，95％CI(0。97，1。94)，P=0。074;RR=0。68，95％CI(0。39，1。19)，P=0。174]。结论:现有的证据表明，在踝关节骨折切开复位内固定术中使用止血带可以缩短手术时间，但同时可能会导致下肢深静脉血栓形成的风险增高、术后疼痛加重、踝关节活动范围减小。
Clinical application value of tourniquet in open reduction and internal fixation of ankle fractures:a meta-analysis
Objective:To systematically review the clinical application value of tourniquet in open reduction and internal fixation(ORIF)of ankle fractures.Methods:All the randomized controlled trial(RCT)articles about using tourniquet in ORIF of ankle fractures in-cluded from database's inception to April 2024 were retrieved from the China National Knowledge Infrastructure,Wanfang Database,Vip Database,Chinese Biomedical Literature Service System,PubMed,Cochrane Library,Web of Science and Embase through computer.A tour-niquet was used in the ORIF of ankle fractures in experimental group and not used in control group.The methodological quality of the in-cluded researches in the articles was evaluated by using bias risk assessment tools recommended by Cochrane handbook for systematic re-views,and then a Meta-analysis was conducted by using RevMan4.3 software.Results:Fifty-three articles were searched out.After screen-ing,6 articles(1347 patients)were included in the final analysis,with 744 patients in experimental group and 603 ones in control group.The results of Meta-analysis revealed that the operative time was shorter,pain visual analogue scale(VAS)score and incidence rate of deep ve-nous thrombosis(DVT)of lower limbs were higher,as well as the ankle range of motion(ROM)was smaller in experimental group compared to control group(MD=-6.80,95％CI(-12.14,-1.46),P=0.013;MD=1.01,95％CI(0.46,1.57),P=0.000;RR=6.34,95％CI(1.45,27.79),P=0.014;MD=-5.25,95％CI(-9.61,-0.89),P=0.018);while,the differences in hospital stay,incidence rates of incision infection and delayed union or nonunion were not statistically significant between the 2 groups(MD=1.88,95％CI(-0.48,4.23),P=0.118;RR=1.37,95％CI(0.97,1.94),P=0.074;RR=0.68,95％CI(0.39,1.19),P=0.174).Conclusion:Available evidences suggest that,using a tourniquet in ORIF of ankle fractures can shorten the operative time,while,it may increase the risk of DVT in the lower limbs,exacerbate the postoperative pain,and reduce the ROM of ankle joint.
ankle fracturestourniquetsfracture fixation,internalmeta-analysis as topic
NETL
NSTL
万方数据
