摘要
目的通过Mata分析评价经皮骶髂螺钉与重建钢板治疗TileC型骨盆后环骨折的临床疗效。方法计算机检索Cochrane图书馆、Medline、Embase、CNKI、万方数据库和中国生物医学文献数据库，手工检索相关文献的参考文献及主要中、英文骨科杂志。收集自建库至2016年12月所有比较经皮骶髂螺钉与重建钢板治疗Tile C型骨盆后环骨折的随机对照研究（RCT）和临床对照研究（CCT），评价纳入研究的方法学质量并提取资料，采用Cochrane协作网提供的RevMan5．2软件进行系统评价。结果共纳入4篇临床研究，其中1篇为RCT，3篇为CCTs，共计334例患者，其中经皮骶髂螺钉组162例，重建钢板组172例（经皮重建钢板组66例，前路重建钢板组106例）。Meta分析结果显示：经皮骶髂螺钉组的手术时间与经皮重建钢板组比较差异无统计学意义（P=0．16），经皮骶髂螺钉组手术时间少于前路重建钢板组，差异有统计学意义（P〈0．001）；经皮骶髂螺钉组切口长度及术中出血量方面均显著小于经皮重建钢板组和前路重建钢板组，差异有统计学意义（P〈0．001），但经皮骶髂螺钉组的术中x线暴露次数显著多于经皮重建钢板组，差异有统计学意义（P〈0．001）；经皮骶髂螺钉组与经皮重建钢板组问骨折复位Matta标准优良率及功能恢复Majeed标准优良率比较差异均无统计学意义（P〉0．05），经皮骶髂螺钉组优于前路重建钢板组，差异有统计学意义（P〈0．001）；经皮骶髂螺钉组的术后并发症发生率显著低于前路重建钢板组，差异有统计学意义（P〈0．001），经皮骶髂螺钉组与经皮重建钢板组的术后骨折部位疼痛发生率差异无统计学意义（P=0．30）。结论与前路重建钢板固定相比，经皮骶髂螺钉和经皮重建钢板固定具有更好的临床疗效和较低的并发症发生率，其中经皮骶髂螺钉在手术切口和术中出血量方面占优，但需要较多的术中x线透视，且技术要求更高。
Objective To assess the clinical efficacy of percutaneous iliosacral screwing versus reconstruction plating in the treatment of pelvic posterior ring fractures of Tile C. Methods The authors retrieved the randomized controlled trials （RCTs） and clinical controlled trials （CCTs） comparing percuta- neous iliosacral screwing versus reconstruction plating for Tile C pelvic posterior ring fractures from the Cochrane library, Medline, Embase, CNKI, Wanfang Data and Chinese Biomedical Database by computer and from major Chinese orth,~pedic journals by hand. Qualified data were extracted by statistical software Revman 5.2 for meta-analysis. Results 334 cases were included in this Meta-analysis from one RCT and 3 CCTs. Of them, 162 underwent percutaneous iliosacral screwing and 172 reconstruction plating （including 66 cases of percutaneous reconstruction plating and 106 ones of anterior reconstruction plating）. There was no significant difference between percutaneous iliosacral screwing and reconstruction plating in operation time （P = 0. 16）. Percutaneous reconstruction plating consumed significantly less operation time than anterior reconstruction plating （ P 〈 0. 001 ）. Percutaneous iliosacral screwing decreased significantly incision length and intraoperative blood loss than both methods of reconstruction plating （ P 〈 0. 001 ）, but significantly increased times of X-ray exposure than percutaneous reconstruction plating （P 〈 0. 001） . There were no significantly differences in the good to excellence rates by Matta scores and Majeed scores between percutaneous iliosacral screwing and percutaneous reconstruction plating （ P 〉 0. 05）, but percutaneous iliosacral screwing performed significantly better than anterior reconstruction plating （ P 〈0. 001 ）. Percutaneous reconstruction plating led to significantly fewer postoperative complications than anterior reconstruction plating （ P 〈 0. 001 ） but similar incidence of postoperative pain at the sacroiliac joint compared with percutaneous reconstruction plating （ P = 0.30）. Conclusion Compared with anterior reconstruction plating, pereutaneous iliosacral screwing and percutaneous reconstruction plating may lead to better clinical efficacy and fewer complications. Percutaneous iliosaeral screwing may be superior in incision length and intraoperative blood loss, but it requires more intraoperative X-ray exposure and more demanding technical skills.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第6期476-483,共8页
Chinese Journal of Orthopaedic Trauma
关键词
骨盆
骨折
骨折固定术
内
系统评价
Pelvis
Fractures, bone
Fracture fixation, internal
Systematic review
