成人胫骨远端骨折选用钢板固定还是髓内钉治疗的Meta分析

发布时间：2018-06-30 02:18

本文选题：胫骨骨折 + 内固定　；参考：《重庆医科大学学报》2017年02期

【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。
[Abstract]:Objective to compare the efficacy of bone plate and intramedullary nail in the treatment of distal tibial fractures in adults. Methods: a computer search was conducted for Pub Medsite Embase Medline, Science Direct Library (issue 11, 2015), Zhiwang, Wanfang and other databases. According to the inclusion and exclusion criteria, the required documents are selected. The rate of postoperative complications, infection rate, malunion rate and delayed or non-union rate were taken as the main analysis index. Meta-analysis was performed with Review Manager 5.3 software. Results: a total of 1 919 cases of distal tibial fractures (773 cases in the plate group and 1 146 cases in the intramedullary nail group) were included in 16 articles. Meta-analysis showed that the total complication rate of the distal tibia fracture in the plate group was not significantly different from that in the intramedullary nail group (OR0.6895CII 0.441.05 P0.080), and the postoperative infection rate was not significantly different between the plate group and the intramedullary nail group. The rate of malunion in the plate group was lower than that in the intramedullary nail group (OR0.34%), and the delayed or non-union rate in the plate group was lower than that in the intramedullary nail group (OR0.34-95CII 0.210.50 P0.000), and the delayed or non-healing rate in the plate group was lower than that in the intramedullary nail group (Ori 0.50t95CI 0.300.83P0. 007). Conclusion: plate treatment or intramedullary nail treatment are common methods in the treatment of distal tibial fractures in adults, each has its own advantages and disadvantages. Intramedullary nail therapy is recommended to reduce the postoperative infection rate when the fracture is accompanied with severe soft tissue injury, and the incidence of delayed healing or nonunion can be reduced by using steel plate when the fracture rotation stability is poor.
【作者单位】：南华大学附属第一医院骨科;河南省驻马店市正阳县人民医院骨科;
【基金】：南华大学研究生创新资助项目(编号:2016XCX42)
【分类号】：R687.3

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