交锁髓内钉与微创经皮钢板治疗成人胫骨中下段骨折的Meta分析  

Interlocking intramedullary nail versus minimally invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults: A meta-analysis

作　　者：张轩轩[1] 隆腾飞[1] 张丕军[1] 赵辉[1] 王钢[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广东省广州市510515

出　　处：《中国组织工程研究》2013年第22期4107-4114,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:临床中治疗成人胫骨中下段骨折的微创内固定方式包括交锁髓内钉技术和微创经皮钢板技术。大量回顾性研究都证实这两种策略临床有效,但两种治疗方法孰优孰劣,目前仍无定论。目的:评价交锁髓内钉技术与微创经皮钢板技术治疗成人胫骨中下段骨折的临床疗效差异。方法:计算机检索PubMed、Embase、Cochrane、CBM、万方、CNKI数据库中比较交锁髓内钉与微创经皮钢板治疗成人胫骨中下段骨折的文章,并手工检索相关中英文杂志,纳入随机对照试验和半随机对照试验。然后,按照Cochrane Collaboration标准对相关文献进行严格的质量评估,选取手术时间、骨折愈合时间、骨组织愈合相关不良事件、软组织愈合相关不良事件、胫骨功能恢复作为评价指标,并用RevMan5.1统计学软件对结果进行Meta分析。结果与结论:共纳入7篇文献,包括377例患者,其中交锁髓内钉组188例,微创经皮钢板组189例。Meta分析结果显示:在治疗胫骨中下段骨折的比较中,两种方法在手术时间[WMD=0.58,95%CI(-28.91,30.07),P=0.97]、软组织相关不良事件发生率[RR=0.51,95%CI(0.22,1.18),P=0.11]及胫骨术后Johnner-Wruhs功能评价优良率[RR=1.03,95%CI(0.91,1.17),P=0.63]等方面差异无显著性意义;而相比于交锁髓内钉组,微创经皮钢板组骨折愈合时间较短[WMD=1.99,95%CI(0.15,3.83),P=0.03],骨组织愈合相关不良事件发生率较低[RR=1.84,95%CI(1.03,3.27),P=0.04]。说明利用交锁髓内钉和微创经皮钢板治疗成人胫骨中下段骨折的疗效基本一致,但微创经皮钢板可缩短患者骨折愈合时间,减少骨折愈合相关不良事件的发生。BACKGROUND： The invasive internal fixation method for the treatment of middle and distal tibial fracture includes interlocking intramedullary naill and minimally invasive percutaneous plate osteosynthesis in clinic, A large number of retrospective studies have confirmed the effectiveness of these two strategies, but there is still no conclusion in which one is better, OBJECTIVE： To compare clinical outcomes of interlocking intramedullary naills and minimally invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults. METHODS： The PubMed database, Embase database, Cochrane database, CBM database, Wangfang database and CNKI database were searched by computer for the articles on interlocking intramedullary naills and minimally invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults, and the relevant Chinese and English orthopedic journals were hand-searched, including randomized controlled trials and quasi-randomized controlled trials. Then, the retrieved studies were strictly evaluated in accordance with the Cochrane Collaboration criteria, and the evaluation index included operation time, fracture healing time, bone tissue healing-related adverse events, soft tissue healing-related adverse events and tibia functional recovery. Meta-analysis was performed using RevMan 5.1 software. RESULTS AND CONCLUSION： A total of 7 articles were screened out, including 377 patients, 188 cases in the interlocking intramedullary naill group and 189 in the minimally invasive percutaneous plate osteosynthesis group. The results of meta-analysis showed that there were no statistically significant differences in the operation time [weighted mean difference=0.58, 95% confidence interval （-28.91, 30.07）, P=0.97], the incidence of bone tissue healing-related adverse events [relative risk=0.51, 95% confidence interval （0.22, 1.18）, P=-0.11], and excellent and good rate of postoperative Johnner-Wruhs function evaluation [relat

关 键 词：骨关节植入物 骨与关节循证医学 骨科植入物 交锁髓内钉 微创经皮钢板 胫骨中下段骨折 META分析 骨不连 微创内固定 骨折愈合 生物学固定 

分 类 号：R318[医药卫生—生物医学工程]