带锁髓内钉与加压钢板治疗胫骨骨折疗效及安全性的Meta分析  

Effects and safety of interlocking intramedullary nails and compression plate for the internal fixation of fracture of tibia:a Meta-analysis of RCTs

作　　者：王升旺[1] 吴宏梓 崔建军 王建民[3] 

机构地区：[1]兰州大学第一临床医学院骨科,730000 [2]瓜州县人民医院外科 [3]兰州大学第一医院骨科

出　　处：《中华临床医师杂志（电子版）》2014年第20期43-47,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的应用系统评价的方法比较胫骨骨折内固定术中应用带锁髓内钉(IIN)与加压钢板(CP)的疗效及安全性,为临床实践与研究提供参考。方法计算机检索Cochrane Library、PubMed、Web of knowledge、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库和CBM(中国生物医学文献数据库),同时辅以其他检索。收集所有比较胫骨骨折内固定术中应用IIN与CP的随机对照试验(RCT),选择适合本研究特点的质量评价标准对纳入文献进行质量评价,使用RevMan 5.2软件进行Meta分析。结果共纳入16篇RCT(1 390例患者)。(1)治疗评价:IIN组的手术时间、术中出血量、住院时间与CP组比较,Meta分析结果分别为MD=-12.18,95%CI(-13.64,-10.72),P<0.000 01;MD=-25.23,95%CI(-30.29,-20.17),P<0.000 0;MD=-3.54,95%CI(-4.43,-2.66),P<0.000 01,其差异均有统计学意义;(2)疗效评价:两组术后优良比、痊显率、膝关节活动度、踝关节活动度的Meta分析结果分别为OR=5.04,95%CI(2.83,8.95),P<0.000 01;OR=5.65,95%CI(1.59,20.07),P=0.007;MD=-4.78,95%CI(-10.33,-0.76),P=0.09;MD=-1.23,95%CI(-2.58,-0.12),P=0.07,可见优良比和痊显率有统计学意义,膝、踝关节活动度无统计学意义;(3)安全性评价:两组术后发生与内固定术相关的并发症,如伤口感染、骨不连、深静脉栓塞、内固定器械折断等均有描述,差异无统计学意义。结论比较CP与IIN治疗胫骨骨折无论是在治疗还是疗效上,IIN都能表现出较为满意的效果。但目前关于Ni-Ti CAC的临床RCT质量较差,结局指标参考标准不统一,尚需大样本高质量的RCT进一步验证。Objective To systematically review the efficacy and safety of interlocking intramedullary nails and compression plate for the fracture of tibia. Methods Standard electronic database were searched to retrieve relevant randomized trials comparing interlocking intramedullary nails with compression plate, which were analyzed systematically using RevMan 5.2. Results Sixteen RCTs including 1 131 patients were brought into this meta analysis. There were significant differences between two groups regarding duration of operation, intraoperative blood loss, length of hospital stay and percent of pass, while no statistically significant difference in range of motion of knee and ankle joint. Interlocking intramedullary nails was not associated with terrible postoperative complications as much as compression plate. Conclusions Interlocking intramedullary nails can achieve and exceed the effect of compression plate in the internal fixation of fracture of tibia. But now the clinical randomized controlled trials about interlocking intramedullary nails is less and the quality is poor, so that its long-term safety evaluation stillnbsp;needs large sample quality RCTs to be further verified.

关 键 词：胫骨骨折 META分析 带锁髓内钉 加压钢板 

分 类 号：R687.3[医药卫生—骨科学]