髓内钉与钢板内固定治疗胫骨远端骨折的Meta分析  

Meta-analysis of Intramedullary Nail and Plate Fixation in Treatment of Distal Tibial Fractures

作　　者：熊国胜[1] 余光书[1] 林焱斌[1] 江小香[2] 王明贺[2] 

机构地区：[1]厦门大学附属福州第二医院创伤骨科,福州350007 [2]福建中医药大学研究生院

出　　处：《中国中医骨伤科杂志》2016年第2期22-28,共7页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨髓内钉与钢板内固定治疗胫骨远端骨折的疗效差异。方法:运用计算机检索PubMed,Cochrane Library,EMBASE,BIOSIS,Ovid databases,中国知网(CNKI)、维普数据库、万方数据库以及手工检索相关文献。收集1990年1月1日至2015年6月1日国内外公开发表的有关髓内钉与钢板内固定治疗胫骨远端骨折的临床疗效对比随机对照的英文与中文文献。严格评价纳入研究的方法学质量并提取资料,统计软件采用RevMan5.1.0.结果:共纳入13个随机对照实验文献,其中英文文献8篇,中文文献5篇。髓内钉治疗组440例,钢板内固定治疗组409例。根据改良后的Jadad评分标准,有6篇文献为高质量文献,7篇文献为低质量文献。Meta分析结果显示,钢板内固定治疗胫骨下段骨折的手术时间少于髓内钉内固定时间(WMD为-10.39,95%CI为-17.59^-3.19,P=0.005);骨折愈合时间短于髓内钉内固定时间(WMD为-5.20,95%CI为-4.11^-0.15,P=0.03),AOFAS评分比髓内钉分数更高(WMD为2.08,95%CI为1.52~2.64,P<0.001);其总的并发症差异无统计学意义(RR为0.75,95%CI为0.47~1.21,P=0.24),但是感染发生率比髓内钉组高(RR为0.59,95%CI为0.36~0.98,P=0.04)。结论:总体而言,髓内钉与钢板内固定各有优缺点,在软组织条件允许的情况下可以优先考虑选择钢板内固定治疗,尤其是应用经皮锁定钢板。Objective：To explore the efficacy difference between intramedullary nail and plate fixation in treating distal tibial fractures.Methods：Relevant references of intramedullary nail and plate fixation treating distal tibial fractures from January 1,1990 to June 1,2015 were searched through PubMed,Cochrane Library,EMBASE,BIOSIS,Ovid databases,China HowNet（CNKI）,VIP database and Wanfang database.The data of the study were strictly evaluated,using RevMan5.1.0for statistical analysis.Results：13randomized control trial references were enrolled,including 8English references and 5Chinese references,440 cases in the intramedullary nail group and 409 cases in the plate fixation group.According to the improved Jadad score standard,there are 6references in high-quality and 7in low-quality.Meta-analysis showed that the operation time of plate fixation is less than intramedullary nail fixation（WMD=-10.39,95% CI=-17.59^-3.19,P=0.005）.The fracture healing time of plate fixation is shorter than that of intramedullary nail fixation（WMD=-5.20,95% CI=-4.11^-0.15,P=0.03）.The AOFAS score in plate fixation group is higher than that in intramedullary nail fixation group（WMD=2.08,95%CI=1.52 P〈0.001）.The overall complication has no significant difference in two groups（RR=0.75,95%CI=0.47~1.21,P=0.24）,but the infection rate in the plate fixation group is higher than that in the intramedullary nail group（RR=0.59,95%CI=0.36~0.98,P=0.04）.Conclusion：There are advantages and disadvantages in intramedullary nail and plate fixation.It prefers to consider plate fixation if the soft tissue permits,especially percutaneous locking plate applications.

关 键 词：胫骨远端骨折 髓内钉 钢板 META分析 

分 类 号：R683.42[医药卫生—骨科学]