双钢板与三钢板内固定治疗Schatzker V~Ⅵ型胫骨平台骨折的Meta分析

Meta-analysis of the Treatment of Schatzker Type V~ⅥTibial Plateau Fractures with Double-plate and Triple-plate Internal Fixation

目的系统评价双钢板与三钢板内固定治疗Schatzker V~Ⅵ型胫骨平台骨折临床疗效,为临床应用提供理论依据。方法运用计算机检索1900年1月1日~2020年8月31日的PubMed、Web of Science、Ovid、Cochrane Library、中国知识资源总库、维普中文科技期刊全文数据库、万方数据学术论文总库、中国生物医学文献服务系统,搜集复杂型胫骨平台骨折临床疗效比较的对照研究。制定入选和剔除标准,筛选出符合纳入标准的文献,评价纳入研究的方法学质量。利用Rev-Man5.3进行Meta分析。结果最终有7篇研究符合纳入标准,共420例患者,其中双钢板组209例,三钢板组211例。Meta分析结果显示:双钢板组与三钢板组的手术时间[MD=-0.74,95%CI(-0.95,-0.53),P<0.00001;Test of SMD=0:z=4.74,P<0.00001]、术中出血量[MD=-0.41,95%CI(-0.62,-0.20),P=0.736;Test of SMD=0:z=3.86,P<0.00001]、膝关节功能恢复优良率[MD=0.21,95%CI(0.11,0.38),P=0.53;Test of OR=1:z=4.83,P=0.000]、HSS评分[MD=-0.82,95%CI(-1.36,-0.27),P=0.001;Test of SMD=0:z=2.93,P=0.003],差异均有统计学意义。双钢板组与三钢板组的骨折愈合时间[MD=-0.64,95%CI(-0.03,1.32),P=0.00000;Test of SMD=0:z=1.87,P=0.062]、术后完全负重时间[MD=-0.87,95%CI(-0.19,1.92),P=0.000;Test of SMD=0:z=1.61,P=0.108]、术后并发症[MD=1.77,95%CI(0.94,3.36),P=0.717;Test of OR=1:z=1.73,P=0.084],差异均无统计学意义。结论两种术式在手术时间及术后恢复情况大致相同情况下,三钢板内固定术相较之下优于双钢板内固定术,可缩短患者骨折愈合时间,有助于患者术后功能康复,但鉴于纳入研究存在选择性偏倚和测量性偏倚的高度可能性,还需更多科学慎密的临床随机对照研究加以证实。

Objective To systematically evaluate the clinical efficacy of double-plate and triple-plate internal fixation in the treatment of Schatzker V~Ⅵtibial plateau fractures,and to provide a theoretical basis for clinical application.Methods A computer was used to search PubMed,Web of Science,Ovid,Cochrane Library,China Knowledge Resources Database,Weipu Chinese Science and Technology Journal Full-text Database,Wanfang Data Academic Papers Database from January 1,1900 to August 31,2020.The Chinese Biomedical Literature Service System collects comparative studies on the clinical efficacy of complex tibial plateau fractures.Formulate selection and rejection criteria,screen out documents that meet the inclusion criteria,and evaluate the methodological quality of the included studies.Meta analysis was performed using Rev-Man5.3.Results In the end,7 studies met the inclusion criteria,with a total of 420 patients,including 209 in the double-plate group and 211 in the three-plate group.Meta-analysis results show:the operation time of the double-plate group and the three-plate group[MD=-0.74,95%CI(-0.95,-0.53),P<0.00001;Test of SMD=0:z=4.74,P<0.00001],intraoperative blood loss[MD=-0.41,95%CI(-0.62,-0.20),P=0.736;Test of SMD=0:z=3.86,P<0.00001],excellent and good rate of knee joint function recovery[MD=0.21,95%CI(0.11,0.38),P=0.53;Test of OR=1:z=4.83,P=0.000],HSS score[MD=-0.82,95%CI(-1.36,-0.27),P=0.001;Test of SMD=0:z=2.93,P=0.003],the differences were statistically significant.The fracture healing time of the double-plate group and the three-plate group[MD=-0.64,95%CI(-0.03,1.32),P=0.00000;Test of SMD=0:z=1.87,P=0.062],postoperative full weight bearing time[MD=-0.87,95%CI(-0.19,1.92),P=0.000;Test of SMD=0:z=1.61,P=0.108],postoperative complications[MD=1.77,95%CI(0.94,3.36),P=0.717;Test of OR=1:z=1.73,P=0.084],the differences were not statistically significant.Conclusion When the operation time and postoperative recovery of the two surgical methods are roughly the same,the three-plate internal fixation is better than the double-plate internal fixation.It can shorten the fracture healing time of patients and help patients recover their functions after surgery.However,in view of the high possibility of selection bias and measurement bias in the included studies,more scientific and rigorous clinical randomized controlled studies are needed to confirm.