植骨与非植骨治疗移位型跟骨关节内骨折疗效比较的meta分析-meta - analysis of curative effect comparison between bone grafting and non-bone grafting in the treatment of displaced intra-articular calcaneal fractures.docx

植骨与非植骨治疗移位型跟骨关节内骨折疗效比较的 Meta 分析 摘要目的：本课题采用 Cochrane 协作网推荐的 Mata 分析方法对植骨与非植骨治疗移位型 跟骨关节内骨折的随机对照试验进行系统评价，旨在比较移位型跟骨关节内骨折术 中植骨与否对治疗效果的影响，以期为临床跟骨骨折治疗方法的选择提供理论依 据。方法：计算机检索 PubMed（1954～2015.3）、EMbase（1954～2015.3）、The Cochrane Library、CNKI（1979～2015.3）、VIP（1989～2015.3）、CBM(1954～2015.3)和WanFang Data（1998～2015.3）等，查找对移位型跟骨关节内骨折术中植骨与不植 骨进行疗效比较的随机对照试验及病例对照研究。按照 Cochrane 协作网的标准，由 2 名评价者依据事先制定的纳入和排除标准独立筛选文献。对纳入的研究进行质量 评价、提取数据、资料，采用 RevMan 5.2 版软件对有效数据进行 Meta 分析。结果：最终共纳入 16 篇文献，16 个临床研究，1299 例患者，其中植骨组 769 例，未 植骨组 530 例。Meta 分析结果显示：在所有结局指标中，足功能优良率[OR=2.12, 95%CI(1.57, 2.86), P＜0.00001]，B?hler 角丢失[MD=-2.66, 95%CI(-3.04, -2.27), P＜0.00001]， 植 骨 组 优 于 未 植 骨组 ； Gissane 角 丢 失 [SMD=-0.39, 95%CI(-1.39, 0.61),P=0.45]、跟骨高度降低[MD=-0.53, 95%CI(-2.19, 1.14), P=0.54]，植骨组与未植骨组间差异无统计学意义。结论：I对于移位型跟骨关节内骨折患者术中给予骨移植能够提高患者术后足功能优良率，从而改善患者的生活质量。关键词： 跟骨骨折；关节内；植骨；系统评价；Meta分析IIMeta-analysis of the Effectiveness of Bone Grafting and Non- Bone Grafting for Displaced Intra-articular Calcaneal Fracture: A Systematic ReviewAbstractObjective:The paper provides a systematical review of treatment of calcaneal fractures by bone grafting and non-bone grafting for displacement of intra-articular calcaneal fractures in the randomized controlled trials (RCTs), with the method of Meta-Analysis recommended by Cochrane. Comparisons of treatment effectiveness by bone grafting and non-bone grafting are made, in order to provide theoretical evidences for the research of clinical treatment methods of calcaneal fractures.Methods:Randomized controlled trials (RCTs) and case-control study of bone grafting and no bone grafting for displaced intra-articular calcaneal fractures were searched in followingdatabases, including PubMed (1954 ～ 2015.3), EMbase (1954 ～ 2015.3), The CochraneLibrary, CNKI (1979 ～ 2015.3), VIP(1989 ～ 2015.3), CBM (1954 ～ 2015.3) andWanFang Data (1998 ～ 2015.3). Two reviewers independently screened the literature according to the criteria of inclusion and exclusion. Data are used and data quality isasses