Treatment of Lesser Metatarsophalangeal Joint Instability With Plantar Plate Repair: A Systematic Review and Meta-Analysis.
Treatment of Lesser Metatarsophalangeal Joint Instability With Plantar Plate Repair: A Systematic Review and Meta-Analysis.
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DOI：
10.1053/j.jfas.2022.02.002
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发表时间：
2022-09
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影响因子：
--
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中科院分区：
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--
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随着时间的推移，对跖趾关节跖板损伤的认识已经得到了改善，因为这种情况已经得到了更广泛的理解和识别。随着跖板损伤作为跖骨痛的一个子集的诊断变得越来越常见，有多种手术选择已被用来解决这种情况。足底板的直接修复已成为足部外科医生的治疗选择，倾向于采用直接背侧入路进行修复。我们使用系统综述和荟萃分析指南的首选报告项目进行了系统综述和荟萃分析，以确定术后视觉模拟量表疼痛和美国骨科足踝协会评分的预期变化幅度。共纳入了12项研究，涉及537例通过背侧（10篇文章）或足底（2篇文章）入路直接修复足底板的足底板撕裂。计算总结估计值，显示纳入研究中患者的视觉模拟量表疼痛改善（术前至术后合并平均变化为−5.01 [95%CI −5.36，−4.66]）和美国骨科足踝协会评分改善（术后合并平均改善40.44 [95%CI 37.90，42.97]）。随机效应模型用于汇总估计。使用I2统计量评估异质性。我们得出结论，在随访2年后，接受直接背侧入路足底钢板修复术的患者的疼痛和功能改善程度可预测。
Recognition of metatarsophalangeal joint plantar plate injuries has improved over time as the condition has become more widely understood and identified. With the diagnosis of a plantar plate injury as a subset of metatarsalgia becoming more common place, there are multiple surgical options that have been utilized to address the condition. Direct repair of the plantar plate has emerged as the treatment of choice for foot surgeons with a tendency to favor a direct dorsal approach for the repair. We performed a systematic review and meta-analysis using preferred reporting items for systematic reviews and meta-analysis guidelines, to determine the magnitude of change that can be expected in visual analog scale pain and American Orthopedic Foot and Ankle Society scores postoperatively. A total of 12 studies involving 537 plantar plate tears were included who underwent direct repair of the plantar plate through either a dorsal (10 articles) or plantar approach (2 articles). Summary estimates were calculated which revealed improvement in visual analog scale pain (pooled mean change of −5.01 [95%CI −5.36, −4.66] pre-to postoperative) and improvement in American Orthopedic Foot and Ankle Society scores (pooled postoperative mean improvement 40.44 [95%CI 37.90, 42.97]) of patients within the included studies. Random effects models were used for summary estimates. I2 statistic was used to assess for heterogeneity. We concluded there is a predictable level of improvement in pain and function in patients undergoing a direct dorsal approach plantar plate repair with follow-up out to 2 years.
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