非金属与金属材料对髌骨骨折内固定术后临床疗效影响的Meta分析

Meta analysis of clinical effects between non-metallic materials and metallic materials by internal fixation for patellar fracture

目的 :系统评价髌骨骨折内固定术中应用金属与非金属材料的临床疗效。方法 :计算机搜索PubMed、EMBASE、Web of science、中国知网(CNKI)和万方数据期刊全文数据库(Wanfang data)发表的对于金属和非金属材料在髌骨骨折术中应用进行比较的病例对照研究,检索时间从建库至2018年6月。由2名研究员按照纳入和排除标准独立筛选文献,提取资料,采用非随机干预性试验偏倚风险评估工具(risk of bias in non-randomised studies of interventions,ROBINS-I)进行文献质量评价。采用RevMan 5.3软件对两种方法术后再手术率、术后临床康复优良率、术后并发症发生率进行Meta分析。结果:最终纳入9个符合条件的回顾性队列研究,共493例。Meta分析结果显示:非金属植入物和金属植入物之间内固定失败再手术率无显著差异[OR=0.52,95%CI(0.25,1.08),P=0.08]。接受非金属植入物后,患者术后临床康复优良率高于接受金属植入物[OR=3.34,95%CI(1.67,6.71),P=0.000 7],总并发症发生率低于接受金属植入物[OR=0.21,95%CI(0.07,0.60),P=0.003]。当去除钢丝克氏针断裂及其产生的皮肤刺激症状并发症后,非金属相关并发症发生率比较,差异无统计学意义[OR=1.08,95%CI(0.45,2.56),P=0.86]。结论:非金属植物可提供与金属植物相同的内固定成功率,且可通过降低金属植物相关并发症的产生,提高患者术后康复优良率。

Objective：To systematically evaluate clinical effects of metal and non-metallic materials in internal fixation for patellar fracture. Methods：The reports concerning about controlled trial of metallic and non-metallic materials for patellar fracture from create database to June 2018 were searched from Pub Med,EMBASE,Web of science,CNKI and Wanfang data.Information was screened and taken out according to inclusion and exclusion criteria by 2 researchers,and risk of bias in non andomised studies of interventions（ROBINS-I） was used to evaluate literature quality. Rate of reoperation,excellent and good rate of clinical rehabilitation,incidence of postoperative complications were compared with Revman 5.3 software for Meta analysis. Results：Totally 9 retrospective cohort studies including 493 patients were selected. There was no significant difference in reoperation rate of internal fixation failure between metallic implants and non-metallic implants [OR=0.52,95% CI（0.25,1.08）P=0.08]. The excellent and good rate of postoperative clinical rehabilitation in patients receiving non-metallic implants were higher than those in receiving metallic implants [OR=3.34,95% CI（1.67,6.71）,P=0.000 7]; incidence of total complications was also lower than that of metallic implants [OR=0.21,95% CI（0.07,0.60）,P=0.003]. There was no significant difference in the incidence of non-metallic related complications after removing Kirschner wire needle and complications of skin irritation[OR =1.08,95% CI（0.45,2.56）,P =0.86]. Conclusion：Non metallic plants could provide the same success rate of internal fixation as metal plants,could improve the excellent and good rate of postoperative rehabilitation by reducing incidence of complications associated with metallic plants. In further,more evidence-level research is needed to confirm in the future.