摘要
目的系统评价经皮空心螺钉(PCS)与钢板内固定(PF)比较治疗踝关节骨折的疗效。方法计算机检索The Cochrane Library(2014年第5期)、Pub Med、EMbase、CBM、CNKI、VIP和Wan Fang Data数据库,查找国内外发表的关于比较PCS与PF治疗踝关节骨折疗效的随机对照试验(RCT)和半随机对照试验(CCT),检索时限均为从建库至2014年5月28日。由2位研究者根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入10个研究,包括3个RCT,7个CCT,共计627例患者。Meta分析结果显示,与PF组相比,PCS组在手术时间[RCT:MD=–6.78,95%CI(–11.95,–1.60),P=0.01;CCT:MD=–9.76,95%CI(–13.68,–5.84),P<0.000 01]、失血量[RCT:MD=–36.14,95%CI(–40.12,–32.17),P<0.000 01;CCT:MD=–34.80,95%CI(–37.78,–31.81),P<0.000 01]和骨折愈合时间方面[RCT:MD=–1.16,95%CI(–1.51,–0.81),P<0.000 01;CCT:MD=–1.55,95%CI(–2.97,–0.13),P=0.03]更少。但两组术后并发症发生率[CCT:OR=0.48,95%CI(0.08,2.81),P=0.41]、AOFAS评分优良率[RCT:OR=2.11,95%CI(0.81,5.49),P=0.12;CCT:OR=1.58,95%CI(0.75,3.30),P=0.23]和术后外踝疼痛率[CCT:OR=0.68,95%CI(0.00,148.82),P=0.89]无明显差异。结论现有证据显示,PCS较之PF在缩短手术时间、减少失血量和缩短骨折愈合时间方面优势明显;而在并发症发生率、AOFAS评分优良率和术后外踝疼痛率方面两者无明显差异。因纳入研究主要为CCT,存在偏倚的高度可能性,故上述结论尚需开展更多高质量研究加以验证。
Objective To systematically review the efficacy of percutaneous cannulated screw（PCS） versus plate fixation（PF） in the treatment of ankle fractures. Methods The Cochrane Library（Issue 5,2014）,Pub Med,EMbase,CBM,CNKI,VIP and Wan Fang Data were searched up to May 28 th 2014,for studies concerning the efficacy of percutaneous cannulated screw versus plate fixation for ankle fractures. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality of included studies. Then,meta-analysis was performed by using Rev Man 5.1 software. Result A total of 10 studies（3 RCTs and 7 CCTs） involving 627 patients were included. The results of meta-analysis showed that： compared with the PF group,the PCS group was superior in time of the operation（RCT： MD = –6.78,95%CI –11.95 to –1.60,P=0.01; CCT： MD= –9.76,95%CI –13.68 to –5.84,P〈0.000 01）,blood loss during the operation（RCT： MD= –36.14,95%CI –40.02 to –32.17,P〈0.000 01; CCT： MD= –34.80,95%CI –37.78 to –31.81,P〈0.000 01） and the time of the fracture healing（RCT： MD= –1.16,95%CI –1.51 to –0.81,P〈0.000 01; CCT： MD= –1.55,95%CI –2.97 to –0.13,P=0.03）; However,there were no statistical differences between the two groups in complication rate（CCT： OR=0.48,95%CI 0.08 to 2.81,P=0.41）,AOFAS score excellent rate（RCT： OR=2.11,95%CI 0.81 to 5.49,P=0.12; CCT： OR=1.58,95%CI 0.75 to 3.30,P=0.23）,and postoperative malleolus pain rate（CCT： OR = 0.68,95%CI 0.00 to 148.82,P=0.89）. Conclusion Current evidence shows that PCS is superior to PF in shorting time of the operation,reducing blood loss during the operation,and shorting time of the fracture healing. However,the complication rate,AOFAS score excellent rate,and postoperative malleolus pain rate are similar for each operation. Due to the quality limitation of the CCTs,the conclusion are needed to be verified by more high quality RCTs in future.
出处
《中国循证医学杂志》
CSCD
2015年第3期335-341,共7页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金资助项目(编号:81171713)
