髓内钉与钢板治疗胫骨远端骨折疗效:Meta分析

Comparison of Clinical Outcome of Intramedullary Nail versus Plating for Distal Tibial Fractures: Meta-Analysis

目的:系统评价髓内钉与钢板治疗胫骨远端骨折的疗效,为临床治疗提供循证证据。方法:检索Pubmed、Springer、Medline、The Cochrane Library、CNKI、万方数据库,中国期刊全文数据库,检索时间2005年1月至2022年1月。收集髓内钉与钢板治疗胫骨远端骨折疗效对比的相关随机对照研究,制定纳入及排除标准,并评估文献质量,采用RevMan5.3软件进行统计分析。结果:共纳入11篇RCT研究,共949例,其中钢板组468例,髓内钉组481例。合并结果显示:两组在手术时间、骨折愈合时间、骨折延期愈合率、骨折不愈合率、深部感染率、畸形愈合率、内固定物取出率方面差异无统计学意义(P > 0.05);而在术后浅表感染率方面钢板组高于髓内钉组(P < 0.05)。结论:髓内钉治疗胫骨远端骨折,在术后浅表感染率方面明显优于钢板组,而无证据显示其在手术时间、骨折愈合时间、骨折延期愈合率、骨折不愈合率、深部感染率、畸形愈合率、内固定物取出率方面优于钢板组。

Objective: To systematically evaluate the efficacy of intramedullary nail and plate in the treatment of distal tibia fracture, and to provide evidence-based evidence for clinical treatment. Methods: Pubmed, Springer, Medline, The Cochrane Library, CNKI, Wanfang Database and Chinese Journal Full-text Database were searched from January 2005 to January 2022. Randomized controlled studies on the efficacy comparison between intramedullary nail and plate in the treatment of distal tibial fractures were collected, inclusion and exclusion criteria were formulated, and literature quality was evaluated. Statistical analysis was performed using RevMan5.3 software. Results: A to-tal of 949 patients were included in 11 RCT studies, including 468 in the plate group and 481 in the intramedullary nail group. The combined results showed that there was no significant difference in operation time, fracture union time, delayed fracture union rate, fracture nonunion rate, deep in-fection rate, malunion rate and internal fixation removal rate between the two groups (P > 0.05). The superficial infection rate in the plate group was higher than that in the intramedullary nail group (P < 0.05). Conclusion: In the treatment of distal tibial fractures, intramedullary nailing is superior to the plate group in terms of postoperative superficial infection rate, but there is no evi-dence that it is superior to the plate group in terms of operation time, fracture union time, delayed fracture union rate, fracture nonunion rate, deep infection rate, malunion rate and internal fixation removal rate.