GustiloⅢ型胫骨骨折的两种治疗方法的Meta分析

Meta-analysis of two theraputic metods for Gustilo Ⅲ type tibial fracture

目的系统评价髓内钉与外固定架治疗GustiloⅢ型胫骨骨折的临床疗效。方法运用计算机检索CLibrary、Pub M、EM、Medline等数据库,搜集GustiloⅢ型胫骨骨折中应用髓内钉或外固定架的临床疗效对比研究,评价纳入研究的方法学质量,按照协作网提供的Rev Man 5.2软件进行系统评价。结果本研究共纳入6篇文献,实验组118例应用髓内钉治疗,对照组122例应用外固定架治疗。Meta分析显示:Meta分析结果显示:髓内钉组的术后感染率低于外固定组,差异有统计学意义(OR=0.33,95%CI(0.16,0.68),P=0.002);髓内钉组的骨折畸形愈合率低于外固定组,差异有统计学意义(OR=0.31,95%CI(0.13,0.74),P=0.008)。结论髓内钉治疗GustiloⅢ型胫骨骨折的术后感染率、骨折畸形愈合率明显低于外固定架,可作为临床治疗的首选方案。

Objective To evaluate the clinical effectiveness of intramedullary nail（ IM） and external fixation（ EF） for Gustilo Ⅲ tibial Fractures. Methods We retrieved CLibrary,Pub M,EM,Medline and other databases,methodological quality assessmnent into research. The analysis was performed using Rev Man 5. 2 software. Results A total of 6 randomized controlled trials involving 240 cases were included. The results of meta-analyses showed that compared with the EF group,postoperative infection and malunion rate was lower in the IM group（ OR = 0. 33,95% CI（ 0. 16,0. 68）,P= 0. 002）（ OR = 0. 31,95% CI（ 0. 13,0. 74）,P = 0. 008）. Conclusion Compared with EF,IM are associated with a lower rate of postoperative infection and malunion. And it should be used as the first-line treatment in clinic.