摘要
目的:Meta分析比较钢板与髓内钉治疗成人胫骨远端骨折的疗效。方法:计算机检索Pub Med、Embase、Ovid、Medline、Science Direct、the Cochrane Library(2015年11期)、知网、万方等数据库。根据纳入和剔除标准筛选出符合要求的文献。以术后全部并发症率、感染率、畸形愈合率和延迟或不愈合率为主要分析指标,用Review Manager 5.3软件进行Meta分析。结果:纳入文献16篇,共1 919例胫骨远端骨折(钢板组773例,髓内钉组1 146例)。Meta分析结果提示胫骨远端骨折,钢板组术后全部并发症率与髓内钉组无统计学差异(OR=0.68,95%CI=0.44~1.05,P=0.080);术后感染率,钢板组高于髓内钉组,有统计学差异(OR=1.85,95%CI=1.21~2.84,P=0.005);术后畸形愈合率,钢板组低于髓内钉组,有统计学差异(OR=0.34,95%CI=0.21~0.50,P=0.000);延迟或不愈合率,钢板组低于髓内钉组,有统计学差异(OR=0.50,95%CI=0.30~0.83,P=0.007)。结论:钢板治疗或髓内钉治疗均是成人胫骨远端骨折治疗中常用的术式,各有优缺点,目前尚不能得出哪种治疗方式更科学。当骨折伴软组织损伤较重时推荐使用髓内钉治疗,可降低术后感染率;当骨折旋转稳定性差时推荐使用钢板治疗,可降低术后延迟愈合或不愈合发生率。
Objective：To compare the efficacy of plate versus intramedullary nailing for distal tibial fracture by Meta-analysis. Methods：Databases of Pub Med,Embase,Ovid,Medline,Science Direct,the Cochrane Library（Issue 11,2015）,Wanfang Data and CNKI were searched. The keywords were tibial fractures,fracture fixation,intramedullary nailing and plate. Full text was screened and downloaded. Retrieval time was from database built to November 2015 in all databases. According to inclusion and exclusion criteria,literature meeting the requirements was screened. The post-operative complication rate,infection rate,deformity healing rate and delay or bone un-union rate were taken as the main observation indexes. The Review Manager 5.3 software was used for Meta-analysis.Results：A total of 16 studies were included,including 1 919 distal tibial fractures（plate group：773 fractures;intramedullary nailing group：1 146 fractures）. Meta-analysis results showed that there was no statistical significance in total postoperative complication rate between plate group versus intramedullary nailing group（OR=0.68,95%CI=0.44 to 1.05,P=0.080）. Postoperative infection rate was higher in plate group than in intramedullary nailing group（OR=1.85,95%CI=1.21 to 2.84,P=0.005）. Postoperative deformity healing rate was lower in plate group than in intramedullary nailing group（OR=0.34,95%CI=0.21 to 0.50,P=0.000）. Postoperative bone delayed union or un-union rate was lower in plate group than in intramedullary nailing group（OR=0.50,95%CI=0.30 to 0.83,P=0.007）.Conclusion：Plate and intramedullary nail are common implant materials in the treatment of distal tibial fractures,each have advantages and disadvantages. With the limited information available at present,no evidence confirmed what kind of treatment is more scientific. Intramedullary nailing treatment is recommended when fracture combining with serious soft tissue injury. Plate treatment can reduce the incidence of post-operative delayed union or un-union when fracture combing with poor rotational stability.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2017年第2期169-175,共7页
Journal of Chongqing Medical University
基金
南华大学研究生创新资助项目(编号:2016XCX42)
关键词
胫骨骨折
内固定
髓内钉
钢板
META分析
tibial fracture
internal fixation
intramedullary nail
bone plates
Meta-analysis
