摘要
目的 :对经皮微创钢板内固定术(MIPPO)与切开复位内固定术(ORIF)治疗成人胫骨远端骨折的疗效进行Meta分析。方法:通过计算机检索Pubmed(1968年至2014年3月),Cochrane图书馆、中国知网数据库(1998年至2014年3月),手工检索相关的中英文骨科杂志。收集MIPPO与ORIF治疗成人胫骨远端骨折的病例对照研究,选择术后感染率、手术时间、术中出血量、骨折不愈合率、骨折延迟愈合、骨折畸形愈合率作为Meta分析的评价指标,按Cochrane协作网推荐的方法进行系统评价。结果 :共纳入5项研究366例患者。Meta分析结果显示:MIPPO组感染率低于ORIF组[OR=0.23,95%CI(0.06,0.92),P=0.04];MIPPO组骨折不愈合率低于ORIF组[OR=0.16,95%CI(0.03,0.76),P=0.02];ORIF组骨折畸形愈合率低于MIPPO组[OR=7.46,95%CI(1.68,33.10),P=0.008];MIPPO组手术时间短于ORIF组[MD=-14.42,95%CI(-27.79,-1.05),P<0.05];MIPPO组术中出血量少于ORIF组[MD=-87.17,95%CI(-99.20,-75.15),P<0.05];两组骨折延迟愈合率比较差异无统计学意义。结论 :对于成人胫骨远端骨折,与切开复位内固定治疗相比,经皮微创钢板内固定治疗手术时间短、出血量较少、术后感染率和骨折不愈合率低,但骨折畸形愈合率高。总体来看MIPPO较ORIF治疗成人胫骨远端骨折更有优势,但最佳治疗方案的选择应结合患者的病情进行综合考虑。
Objective：To perform a meta analysis on clinical outcomes of minimally invasive percutaneous plate osteosynthesis（MIPPO） or open reduction and internal fixation（ORIF） for distal tibial fractures in adults. Methods：Pubmed database（from 1968 to March 2014）,Cochrane library and CNKI database（from 1998 to March 2014） were searched. Case control study on minimally invasive percutaneous plate osteosynthesis（MIPPO） or open reduction and internal fixation（ORIF） for distal tibial fractures in adults were chosen,and postoperative infection,operative time,blood loss,fracture nonunion rate,delayed union,fracture malunion rate were seen as evaluation index for meta analysis. The system review was performed using the method recommended by the Cochrane Collaboration. Results：Totally 5 studies（366 patients） were enrolled. Meta analysis showed that there were significant meaning in postoperative infection between MIPPO and ORIF [OR=0.23,95% CI（0.06,0.92）,P =0.04];fracture nonunion rate in MIPPO was lower than in ORIF group [OR =0.16,95% CI（0.03,0.76）,P =0.02];operative time in MIPPO was shorter than in ORIF group,and had significant difference [MD =-14.42,95%CI（-27.79,-1.05）,P〈0.05];blood loss in MIPPO was less than in ORIF group [MD =-87.17,95% CI（-99.20,-75.15）,P〈0.05];there was no obviously meaning in delayed union between two groups. Conclusion：For distal tibial fractures in adults,MIPPO has advantages of short operative time,less blood loss,lower incidence of infection and fracture non uniom,but with high fracture malunion rate. MIPPO for distal tibial fractures in adults is better than ORIF,and the best treatment should choose according to patient＇s condition.
出处
《中国骨伤》
CAS
2015年第8期757-762,共6页
China Journal of Orthopaedics and Traumatology
基金
国家自然科学基金(编号:81372013)~~
关键词
胫骨骨折
骨折固定术
内
META分析
Tibial fractures
Fracture fixation
internal
Meta-analysis
