外固定架结合有限切开复位内固定与切开复位内固定治疗胫骨Pilon骨折的Meta分析

A meta-analysis of postoperative complications in tibial Pilon fracture: open reduction and internal fixation versus limited internal fixation combined with external fixator

目的比较外固定架结合有限切开复位内固定(LIFEF)与切开复位内固定治疗(ORIF)治疗胫骨Pilon骨折的利弊,为临床外科医师提供诊疗方向,为指南的制定提供理论依据。方法计算机检索Pubmed、Science Direct、Wiley Online Library、the Cochrane Library、CNKI、VIP及万方数据库,收集ORIF与LIFEF相比较治疗成人胫骨Pilon骨折的研究报告。两人独立完成数据录入,采用STATA 12.0软件进行数据分析。结果本研究纳入的33篇文章中有2054例骨折患者进行分析,结果表明2组在Mazuretal踝关节评价结果(RR=1.10,95%CI:1.02~1.19,P=0.021)、骨髓炎(RR=0.47,95%CI:0.23~0.96,P=0.015)、创伤性关节炎(RR=1.55,95%CI:1.22~1.96,P=0.00)发生率上比较,差异均有统计学意义(P<0.05)。在组织感染(RR=1.13,95%CI:0.78~1.64,P=0.511)发生率上比较,差异无统计学意义(P>0.05)。结论 LIFEF组总的并发症发生率较ORIF低,LIFEF术后愈后较好。

Objective To perform a meta-analysis to analyze the advantages and disadvantages of open reduction and internal fixation(ORIF)versus limited internal fixation combined with external fixator(LIFEF),to provide rational clinical diagnosis and treatment methods for orthopedic surgeons and provide a theoretical basis for the development of guidelines.Methods Controlled clinical trials on ORIF and LIFEF for the treatment of tibial Pilon fracture were searched in PubMed,Science Direct,Wiley Online Library,Cochrane Library,CNKI,VIP,and Wanfang databases.Data were screened,extracted,and evaluated by two independent researchers.A meta-analysis was performed using STATA12.0.Results Thirty-six studies with 2054 fractures in 2054 patients were included in the present study.We found that there were significant differences in Ankle score of Mazuretal(RR=1.10,95%CI:1.02-1.19,P=0.021),osteomyelitis(RR=0.47,95%CI:0.23-0.96,P=0.015),and traumatic arthritis(RR=1.55,95%CI:1.22-1.96,P=0.00),but no significant difference in soft tissue infection(RR=1.13,95%CI:0.78-1.64,P=0.511).Conclusion LIFEF is associated with a lower rate of overall incidence complications than ORIF and may have better effect.