胫骨近端关节外骨折髓内钉与钢板内固定术后并发症比较的系统评价

Complications of plating versus intramedullary nailing for proximal extra-articular tibia fractures:a systematic review

目的比较胫骨近端关节外骨折使用髓内钉与钢板内固定术后的并发症情况。方法计算机检索自2009-01—2021-01中国知网、万方、维普、PubMed、Embassy、Cochrane等数据库收录的关于髓内钉与钢板内固定治疗胫骨近端关节外骨折的文献,提取有效数据并比较髓内钉组与钢板组术后并发症发生情况。结果纳入13篇文献,其中8篇随机对照试验,3篇前瞻性病例对照研究,2篇回顾性研究。共1043例胫骨近端关节外骨折,其中髓内钉组516例,钢板组527例。系统评价结果显示,髓内钉组与钢板组总体并发症发生率、骨折延迟愈合或不愈合发生率、骨折畸形愈合发生率差异无统计学意义(P>0.05);钢板组术后感染发生率高于髓内钉组,而髓内钉组膝前疼痛发生率高于钢板组,差异有统计学意义(P<0.05)。结论对于胫骨近端关节外骨折而言,钢板内固定术后感染发生风险较髓内钉固定高,而髓内钉内固定术后更容易发生膝前疼痛。但是上述结论仍需开展更大样本及严谨设计的随机对照试验加以论证。

Objective To evaluate and compare the complications of plating versus intramedullary nail in treating the proximal extra-articular tibia fractures.Methods Articles and literatures of plating and intramedually nail treating proximal tibia fractures were searched from CNKI,Wanfang Data,Vip,Pubmed,Embassy and Cochrane Library scholar from January 2009 to January 2021.The complications were compared between plating group and intramedullary nail group.Results Thirteen articles were collected,including 8 randomized controlled trials,3 prospective control and 2 retrospective studies.There were 1043 cases of proximal extra-articular tibia fracture,516 cases were included in the intramedullary nail group,and 527 cases in the plating group.The systematic review results showed that compared with plating group,intramedullary nail group was associated with significantly lower risk of infection incidence,but higher rate of knee pain(P<0.05).Besides,there was no significant difference in total complications,delayed union,nonunion and malunion(P>0.05).Conclusion In the treatment of the proximal extra-articular tibia fractures,intramedullary nail fixation shows that lower rate of infection occurres than plating fixation,but anterior knee pain is more likely to occur after intramedullary nail fixation.However,higher quality,randomized controlled studies are needed to prove this conclusion.