微创钢板固定与髓内钉固定治疗胫骨AO 43-A型骨折疗效的Meta分析

Minimally invasive plate osteosynthesis versus intramedullary nailing for AO 43-A type tibial fracture: A Meta-analysis

目的应用Meta分析评价胫骨AO 43-A型骨折采用微创钢板固定与髓内钉固定的疗效差异,为临床治疗提供参考依据。方法计算机检索Pub Med、Embase、Springer、Cochrane Library、中国知网(CNKI)、万方数据库,检索时间为数据库建库至2018年3月。根据纳入与排除标准进行随机对照试验(RCTs)和临床对照试验(CCTs)的筛选、数据采集和质量评价,然后应用Rev Man 5.3软件进行分析,并采用GRADE系统进行证据质量评价。结果共纳入8篇临床研究,3篇RCTs,5篇CCTs,微创钢板组284例,髓内钉组278例,总计562例。Meta分析结果显示与髓内钉固定比较,微创钢板固定骨折畸形愈合发生率与膝前痛发生率低,差异均有统计学意义(均P<0.05);与微创钢板固定比较,髓内钉固定手术时间短、完全承重时间早、伤口并发症发生率低、术后功能评分高,差异均有统计学意义(均P<0.05);但两组愈合时间、骨折延迟愈合发生率比较差异均无统计学意义(均P>0.05)。结论微创钢板固定拥有更低的骨折畸形愈合发生率及膝前痛发生率,而髓内钉固定在手术时间、完全承重时间、伤口并发症发生率、术后功能评分方面更具优势,是目前更有效的治疗手段。

Objective To compare the clinical efficacy of minimally invasive plate osteosynthesis( MIPO) with intramedullary nailing(IMN) for AO 43-A type tibial fracture(DTF). Methods Pub Med, Embase, Springer, Cochrane Library, CNKI, WANFANG database and specific orthopedics journals were searched from inception to March 2018. Randomized controlled trials(RCTs) and clinical controlled trials(CCTs)were screened, data collected and quality assessed according to inclusion exclusion criteria. Rev Man 5.3 software was used for analysis, and GRADE system was used to evaluate the quality of evidence. Results Three RCTs and five CCTs involving 562 patients were included for analysis. MIPO had a lower malunion rate and anterior knee pain than IMN(both P <0.05). However, IMN was probably preferential to plating for DTF given its shorter time to operation and full weight time, lower risk of infection, higher functional score(all P<0.05). However, there was no significant difference in healing time and delayed healing rate between the two groups(both P >0.05). Conclusion MIPO shows lower malunion rate and anterior knee pain for fixation of AO 43-A type DTF. However, IMN may be preferential to MIPO for fixation with quicker operation and early full weight time, lower risk of infection and better function.