Meta Analysis Of Dynamic Fixation And Static Fixation In The Treatment Of Distal Tibiofibular Syndesmosis Injury

Objective: This study conducted a meta-analysis on the efficacy of dynamic fixation and static fixation in the treatment of distal tibiofibular syndesmosis injury.By collecting domestic and foreign literature and extracting data,statistical methods were used to analyze whether there were statistical differences in the clinical efficacy of the two surgical regimens,which provided references for clinicians and patients from the perspective of individuals,hospitals and society,aiming to help select the best surgical program.Methods: Pub Med,Cochrane libraries,China national knowledge network full-text database,wanfang database and VIP database were searched comprehensively to obtain literature about dynamic fixation and static fixation treatment of distal tibiofibular syndesmosis injury and tibiofibular syndesmosist injury,We searched keywords "Dynamic fixation","static fixation","distal tibiofibular syndesmosis " and "tibiofibular syndesmosist" in the Chinese database and keywords "distal tibiofibular syndesmosis","tibiofibular syndesmosist","Dynamic fixation","static fixation" in the English database.Review Manager 5.2 was used for Meta analysis of relevant data in the literature.Results: a total of 10 Chinese and English literatures were included in this meta-analysis,including 5 RCT and 5 CCT,with a total of 486 cases,among which236 cases were dynamically fixed group and 250 cases were statically fixed group.We extracted the American orthopaedic foot and ankle society(AOFAS)score,full weight-bearing time,complications(including wound infection,local irritation or discomfort,loose screws,screw fracture),medial,tibiofibula clearance,clearance tibiofibula overlapping data,using the Review Manager 5.2 Meta analysis.The results showed that the dynamic fixation group in postoperative 3,6,12,24 months AOFAS score were significantly higher than the same period of static fixation group(P = 0.02,P = 0.03,P = 0.04,P = 0.02),and the loading time of the dynamic fixed group was significantly earlier than that of the static fixed group(P= 0.01).In terms of complications,the incidence of postoperative complications(screw loosening and screw breakage)in the dynamic fixation group was lower than that in the static fixation group(P= 0.007,P < 0.0001),and there was no significant difference between the two groups in medial space(P= 0.72),tibiofibular space(P= 0.97)and tibiofibular overlap(P = 0.95).Conclusion: based on the retrieved literature,this Meta-analysis showed that,compared with the static fixed,the dynamic fixed methods had obvious advantages,it can improve the AOFAS score,reduce the time required for full load,postoperative cortical screw fracture and the risk of cortical screw loose.But few literatures were included in this paper,we need more randomized controlled trials for further research.