摘要目的 通过对已发表文献进行汇总分析,总结踝关节置换术并发症的发生率和假体失败率,并总结导致假体失败的高危并发症.方法 通过系统检索1995年1月至2010年12月以英文发表的关于踝关节置换中长期疗效和并发症相关报道的文献.根据纳入标准或排除标准,收集相关结果和数据,通过循证医学meta分析方法,加权汇总分析踝关节置换的手术并发症发生率和假体失败率,总结导致假体失败的高危并发症,并分别汇总各种假体的失败率.结果 有35篇文献纳入研究,共包括4395例假体.发生率最高的三项并发症分别为无菌性松动(12.51%)、术中骨折(11.97%)和骨性撞击(11.27%);导致失败率最高的三项并发症分别为无菌性松动(45.00%)、感染(33.00%)和力线异常(29.00%).meta加权失败率为10.98%(95% CI:8.80%～13.16%),其中STAR假体的失败率为14.20%(95%CI:10.64%～17.76%).结论 无菌性松动、感染和力线异常为踝关节置换术后假体失败的高危并发症,应通过完善的手术操作和合理的术后配合尽量避免其发生.

abstractsObjectives To provide a cumulative data about the complications of second or third generation ankle prostheses in the literature, and to provide a summary high-grade complications associated with implant failure.Methods A comprehensive search for all relevant articles published in English from January 1995 to December 2010 was conducted.Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest Meta-analytic pooling of results across studies was performed for the complications and failure rate. Results Thirty-five primary studies with 4395implants were identified.The three highest complications of total ankle arthroplasty were aseptic loosening ( 12.51% ), intra-operative bone fracture ( 11.97% ) and bony impingement ( 11.27% ).The three high-grade complications associated with implant failure were aseptic loosening (45.00%), infection (33.00%)and malalignment (29.00%).The pooled mean failure rate was 10.98% (95% CI:8.80% -13.16% ), and the pooled mean failure rate of STAR implant was 14.20% (95% CI:10.64% -17.76% ).Conclusions It is found that aseptic loosening, infection and malalignment are high-grade complications associated with implant failure in total ankle arthroplasty.The orthopaedic surgeons should be more careful in the operation,and the patients should coordinate with the post-operative rehabilitation plan.