摘要目的 比较第一跖趾关节融合术与成形术治疗类风湿前足畸形的临床疗效.方法 计算机检索PubMed(1990年1月至2012年6月)、CNKI(1990年1月至2012年6月)、OVID(1996年1月至2012年6月)、中国生物医学文献光盘数据库、EMBASE(1966年1月至2012年6月)、万方数据库(1990年1月至2012年6月)和Cochrane Library(2011年第3期),搜集第一跖趾关节融合术与关节成形术比较治疗类风湿前足畸形的随机对照研究,对纳入的文献选择患者满意度、(足母)趾区负重、AOFAS穿鞋评分、外观评分、足功能指数评分、(足母)外翻角、第一、二跖骨间角、手术时间、并发症作为系统评价的指标.采用RevMan 5.1进行分析.结果 共纳入5项研究,285例患者.Meta分析显示:第一跖趾关节融合术的AOFAS穿鞋评分、外观评分优于第一跖趾关节成形术[MD=-0.88,95％CI(-1.55,-0.22),P=0.010;MD=-5.04,95％CI(-8.94,-1.14),P=0.01],矫正第一、二跖骨间角、(足母)外翻角的能力较成形组好[MD=1.43,95％CI (0.37,2.48),P=0.008；MD=13.27,95％CI (11.44,15.09),P＜ 0.00001]、并发症少[OR=2.32,95％CI(1.06,5.05),P=0.03].而患者满意度、足功能指数评分,两组疗效相当.结论 第一跖趾关节融合术联合二至五趾跖骨头切除成形术治疗类风湿前足畸形,可有效缓解疼痛、改善足的外观及功能、术后并发症少,其疗效优于第一跖趾关节成形术.

abstractsObjective To evaluate the efficacy of the first metatarsophalangeal joint arthrodesis versus resection arthroplasty for rheumatoid forefoot deformity.Methods Randomized controlled studies in the first metatarsophalangeal joint arthrodesis versus resection arthroplasty for rheumatoid forefoot deformity were collected in data bases like Cochrane library (Issue 3,2011),OVID (from January 1996 to June 2012),PubMed (from January 1990 to June 2012),CNKI (from January 1990 to June 2012),CBM,EMBASE (from January 1966 to June 2012) and Wanfang (from January 1990 to June 2012).Software RevMan 5.1 was used to analyze the trials included in terms of patient satisfaction,hallux area weight-bearing,AOFAS score,FFI score,HAV angle,IMA angle,operative time and complications.Results The totals of 5 RCTs were included in the study which involved 285 patients.The results of meta-analysis showed that the efficacy of the arthrodesis group was superior to that of the arthroplasty group in footwear (MD=-0.88,95％CI [-1.55,-0.22],P=0.010)and alignment (MD=-5.04,95％CI [-8.94,-1.14],P=0.01) significantly.The arthrodesis group also has an advantage of IMA and HAV angle correction (MD=1.43,95％CI [0.37,2.48],P=0.008; MD=13.27,95％CI [11.44,15.09],P＜ 0.00001).Significant difference was found between the two groups in the rate of complications.The rate of complication in the arthrodesis group was lower than that of the arthroplasty group (OR=2.32,95％CI [1.06,5.05],P=0.03).No significant difference was found between the two groups in patient satisfaction and FFI score.Conclusion Compared with resection arthroplasty,first metatarsophalangeal joint arthrodesis could be a better choice.It alleviates the pain effectively,improves the appearance and functions of the foot,and has a lower rate of postoperative complications.