髓内钉与微创经皮接骨板治疗胫骨远端骨折疗效的Meta分析

Intramedullary nailing versus minimally invasive percutaneous plate osteosynthesis in treatment of distal tibial fracture:a meta-analysis

目的通过Meta分析比较髓内钉(IMN)与微创经皮接骨板(MIPPO)治疗胫骨远端骨折的疗效。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、Pubmed、Embase、Cochrane、Web of Science数据库2010年1月至2020年8月国内外正式刊物上公开发表的有关IMN与MIPPO治疗胫骨远端骨折的文献。纳入的研究由2名研究人员根据Cochrane偏倚风险标准进行评估。主要指标为手术时间、骨折愈合时间、浅表感染率、深部感染率、骨折畸形愈合率、骨折延迟愈合率或不愈合率、软组织刺激率,采用Review Manager 5.3软件进行数据分析。结果共纳入7项研究653例患者,其中IMN组325例,MIPPO组328例。Meta分析显示:IMN组手术时间短于MIPPO组(MD=-10.75,95%CI:-19.92~-1.58,P=0.02),IMN组的浅表感染率低于MIPPO组(RR=0.58,95%CI:0.39~0.88,P=0.01),IMN组的骨折畸形愈合率高于MIPPO组(RR=1.87,95%CI:1.15~3.04,P=0.01);软组织刺激率中,IMN组的膝前痛发生率高于MIPPO组(RR=16.98,95%CI:3.30~87.34,P=0.0007),而IMN组骨折处软组织刺激的发生率低于MIPPO组(RR=0.13,95%CI:0.04~0.40,P=0.0004),差异均有统计学意义。两组的骨折愈合时间、深部感染率、骨折延迟愈合率或不愈合率差异均无统计学意义(P>0.05)。结论IMN和MIPPO均是治疗胫骨远端骨折的优良方法,IMN在预防浅表组织感染表现得更为出色,但膝前痛发生概率较大,而MIPPO在防止骨折愈合畸形方面优于IMN,但骨折处软组织刺激可能性较大,建议胫前软组织条件良好时采用MIPPO,反之,则建议使用IMN来降低软组织感染率。

Objective To compare the efficacy between intramedullary nailing(IMN)and minimally invasive percutaneous pate oteosynthesis(MIPPO)in the treatment of distal tibial fractures.Methods China National Knowledge Infrastructure(CNKI),Wanfang Database,Chinese Biomedical Literature Database,Pubmed,Embase,Cochrane,and Web of Science databases were searched by computer for publications on IMN and MIPPO in the treatment of distal tibial fractures published in official journals at home and abroad from January 2010 to August 2020.The studies included were evaluated by 2 authors using the Cochrane collaboration’s tool for assessing risk of bias.The main extraction indexes were operation time,union time,superficial infection,deep infection,malunion,delayed union or nonunion,and soft tissue irritation.Review Manager 5.3 software was used for data analysis.Results A total of 7 studies with 653 patients were included,with 325 in the IMN group and 328 in the MIPPO group.Meta analysis showed the following:operation time in the IMN group was significantly shorter than that in the MIPPO group(MD=-10.75,95%CI:-19.92~-1.58,P=0.02);superficial infection rate in the IMN group was significantly lower than that in the MIPPO group(RR=0.58,95%CI:0.39~0.88,P=0.01);fracture malunion rate in the IMN group was significantly higher than that in the MIPPO group(RR=1.87,95%CI:1.15~3.04,P=0.01).Concerning soft tissue irritation,incidence of anterior knee pain in the IMN group was significantly higher than that in the MIPPO group(RR=16.98,95%CI:3.30~87.34,P=0.0007)while incidence of soft tissue irritation at the fracture site in the IMN group was significantly lower than that in the MIPPO group(RR=0.13,95%CI:0.04~0.40,P=0.0004).There were no significant differences between the 2 groups in fracture healing time,deep infection rate,delayed union rate or nonunion rate(P>0.05).Conclusions Although both IMN and MIPPO are fine treatments of distal tibial fractures,IMN may be superior in prevention of superficial tissue infection but prone to anterior knee pain while MIPPO may be superior in prevention of malunion but prone to soft tissue irritation at the fracture site.Therefore,MIPPO is suggested in cases with fine pretibial soft tissues while IMN is used to reduce soft tissue infection otherwise.