1484例胫骨下段骨折的临床疗效评价

Treatment of distal tibia fractures without articular involvement:a systematic review of 1484 fractures

[目的]本研究通过系统回顾不同方法治疗胫骨下段骨折的英文文献,对其畸形愈合率、不愈合率、感染率、内固定失败率及二次手术率等进行评价。[方法]2位作者独立计算机检索PubMed数据库,Embase,Co-chrane library,CBM和相关的会议记录及相关文献的参考文献,检索无语种限制。筛选出符合纳入标准的文献,对其进行严格的质量评价,采用SPSS 19.0对纳入研究结果进行分析。[结果]初检获得相关文献721篇,最后纳入22篇,共1 484例。保守治疗组(n=556)的不愈合率为1.3%,明显低于髓内针固定组(RR:0.22;CI:0.01～0.71;P<0.001)的5.8%和钢板内固定组(n=310)的3.7%(RR:0.35;CI:0.01～0.91;P=0.02)。钢板内固定组的畸形愈合率为7.7%,明显低于保守治疗组的15.5%(RR:0.50;CI:0.21～0.73;P=0.001)和髓内针固定组的14.6%(RR,0.53;CI:0.23～0.77;P=0.003)。钢板固定组的二次手术率为8.1%,明显低于髓内针固定组的18.3%,(RR:0.44;CI:0.22～0.69;P<0.001)。[结论]保守治疗组的不愈合率明显低于手术治疗组,但保守治疗组的畸形愈合率明显高于钢板内固定组。钢板内固定组的畸形愈合率和二次手术率明显低于髓内针固定组。

[ Objective] This study was designed to review the outcomes of different treatment methods for extra-articular distal tibia fractures in English literatures. To evaluate and compare the rates of malunion, nonunion, infection, fixation failure, and secondary surgical procedures. [ Method ] Literatures on treatment of distal tibia fractures without articular involvement pubfished from 1975 to January 2011 were retrieved from Cochrane library, Medline, Embase databank, and Chinese Biomedical Database. Relevant articles were handsearched. Quality of the trials was critically assessed and the rates of malunion, nonunion, infection, fixation failure, and secondary procedures were extracted. The software SPSS 19.0 was used for meta-analysis. [ Result] A total of 22 studies among 721 literatures were identified and 1482 cases were included. The nonunion rate of nonoperative treatment was significantly lower than that in operative treatment. The rates of malunion trended lower in the plating group than in the nonoperative group （RR ：0.50, CI：0.21 -0.73, P = 0. 001 ）. The rates of malunion trended lower in the plating group than the rate in the nonoperative group. Malunion and secondary procedures appeared more frequently in the intramedullary nail- ing group than in the plating group （ RR,0.53, C1：0.23 - 0.77, P = 0. 003 ） （ RR ： O. 44, CI ： 0.22 - 0.69, P 〈 0.001 ）. [ Con- clusion] The patients undergoing intramedullary nailing are more likely to have fracture malunion and secondary procedures. The nonunion rate of nonoperative treatment is significantly lower than operative treatment. The malunion rate of nonoperative treat- ment is higher than plating group.