中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (36): 5888-5896.doi: 10.12307/2021.359

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

环形外固定和钢板内固定治疗胫骨平台骨折术后并发症的Meta分析

宋  磊1，张  晖1，赵阳飞1，孙海钰2   

  1. 1山西医科大学，山西省太原市   030000；2山西医科大学第二医院骨科，山西省太原市   030000
  • 收稿日期:2021-03-02 修回日期:2021-03-04 接受日期:2021-03-31 出版日期:2021-12-28 发布日期:2021-09-18
  • 通讯作者: 孙海钰，博士，主任医师，山西医科大学第二医院骨科，山西省太原市 030000
  • 作者简介:宋磊，男，1992年生，汉族，山西省吕梁市人，山西医科大学在读硕士，医师。

Meta-analysis of postoperative complications of circular external fixation and internal fixation with steel plate for the treatment of tibial plateau fractures

Song Lei1, Zhang Hui1, Zhao Yangfei1, Sun Haiyu2   

  1. 1Shanxi Medical University, Taiyuan 030000, Shanxi Province, China; 2Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • Received:2021-03-02 Revised:2021-03-04 Accepted:2021-03-31 Online:2021-12-28 Published:2021-09-18
  • Contact: Sun Haiyu, MD, Chief physician, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • About author:Song Lei, Master candidate, Physician, Shanxi Medical University, Taiyuan 030000, Shanxi Province, China

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摘要：


文题释义：

钢板内固定治疗：前路应用钢板螺钉切开复位内固定治疗胫骨平台骨折。
环形外固定治疗：应用Taylor空间架、Ilizarov环形架及Monticelli-Spinelli环形架等外固定器微创治疗胫骨平台骨折。

目的：关于环形外固定和切开复位钢板内固定治疗胫骨平台骨折的术后并发症仍存在争议，需要用循证医学的方法来评价两种治疗方式的优劣。文章比较环形外固定和切开复位钢板内固定治疗胫骨平台骨折的临床效果差异。
方法：计算机检索PubMed、EMbase、Cochrane Library、中国知网和万方医学网数据库，搜集相关内外固定治疗复杂胫骨平台骨折的研究文献。由2名独立研究者筛选文献、按照标准收集文献，采用Cochrane评分标准评估随机对照试验质量，采用NOS量表评估纳入队列研究的质量，提取相关数据后，应用RevMan 5.3软件进行Meta分析。
结果：①最终纳入14篇文献，3篇为随机对照试验，11篇为队列研究，共882例患者， 观察组436例采用钢板内固定治疗，对照组446例采用环形外固定治疗；②文献质量评价结果显示，3篇随机对照试验均为中高质量文献；11篇队列研究中，3篇为高质量文献，7篇为较高质量文献，1篇为中等质量文献；③Meta分析结果显示：与外固定治疗相比，切开复位内固定可显著降低术后总感染率(OR=0.31，95%CI：0.17-0.57，P=0.000 1)、浅表感染率(OR=0.28，95%CI：0.13-0.58，P=0.000 7)、骨折畸形愈合率(OR=0.40，95%CI：0.21-0.75，P=0.004)和不良事件发生率(OR=0.26，95%CI：0.16-0.42，P < 0.000 01)；但并未降低深部感染率(OR=0.64，95%CI：0.34-1.19，P=0.16)、继发性骨关节炎发生率(OR=0.66，95%CI：0.39-1.12，P=0.12)、二次手术率(OR=0.69，95%CI：0.39-1.22，P=0.20)、术后膝关节僵直发生率(OR=0.92，95%CI：0.32-2.67，P=0.89)、腓浅神经损伤率(OR=0.38，95%CI：0.10-1.45，P=0.16)、术后血栓发生率(OR=0.29，95%CI：0.08-1.08，P=0.06)和骨折不愈合率(OR=0.80，95%CI：0.19-3.35，P=0.76)；对骨折畸形愈合行亚组分析结果显示，Hoffmann外固定更易造成关节面畸形愈合(OR=0.13，95%CI：0.04-0.39，P=0.000 3)。

结论：钢板内固定治疗胫骨平台骨折，在浅表感染、骨折畸形愈合及总感染率方面临床疗效优于环形外固定，但是Hoffman外固定更易造成关节面畸形愈合。

https://orcid.org/0000-0001-7964-6311 (宋磊) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 胫骨, 骨折, 胫骨平台骨折, 外固定, 内固定, 内固定, Meta分析, 系统评价

Abstract: OBJECTIVE:  There are still controversies about the postoperative complications of circular external fixation and open reduction and internal fixation with steel plates for the treatment of tibial plateau fractures. Evidence-based medicine methods are needed to evaluate the pros and cons of the two treatments. This article compared the clinical effects of circular external fixation and open reduction and internal fixation with steel plate in the treatment of tibial plateau fractures.
METHODS: Computer was used to to collect articles on relevant internal and external fixation for the treatment of complex tibial plateau fractures in PubMed, EMbase, Cochrane Library, CNKI, Wanfang and other databases. Two independent investigators screened the literature and collected the literature according to the standards. The Cochrane scoring standard was used to evaluate the quality of the randomized controlled trials, and the NOS scale was used to evaluate the quality of the cohort study. After relevant data were extracted, the RevMan 5.3 software was used for meta-analysis.  
RESULTS:  (1) Finally, 14 articles were included: 3 articles were randomized controlled trials, and 11 articles were cohort studies, with a total of 882 patients. 436 cases in the observation group received internal fixation with steel plate, and 446 cases in the control group received circular external fixation. (2) Literature quality evaluation results showed that 3 randomized controlled trials were all medium-and high-quality literature. Among 11 cohort studies, 3 were high-quality literature; 7 were higher-quality literature; and 1 was medium-quality literature. (3) Meta-analysis results showed that compared with external fixation, open reduction and internal fixation could significantly reduce the total postoperative infection rate (OR=0.31, 95%CI: 0.17-0.57, P=0.000 1) and the superficial infection rate (OR=0.28, 95%CI:0.13-0.58, P=0.000 7) and fracture malunion rate (OR=0.40, 95%CI:0.21-0.75, P=0.004) and adverse event rate (OR=0.26, 95%CI:0.16-0.42, P < 0.000 01); but did not reduce the deep infection rate (OR=0.64, 95%CI:0.34-1.19, P=0.16), the incidence of secondary osteoarthritis (OR=0.66, 95%CI:0.39-1.12, P=0.12), the rate of secondary operations (OR=0.69, 95%CI:0.39-1.22, P=0.20), postoperative knee stiffness incidence (OR=0.92, 95%CI:0.32-2.67, P=0.89), postoperative nerve injury rate (OR=0.38, 95%CI:0.10-1.45, P=0.16), postoperative thrombosis rate (OR=0.29, 95%CI: 0.08-1.08, P=0.06) and fracture nonunion rate (OR=0.80, 95%CI:0.19-3.35, P=0.76). The results of subgroup analysis of fracture malunion showed that Hoffmann external fixation was more likely to cause articular surface malunion (OR=0.13, 95%CI: 0.04-0.39, P=0.000 3).  
CONCLUSION: In the treatment of tibial plateau fractures, plate internal fixation is superior to circular external fixation in terms of superficial infection, fracture malunion and total infection rate. However, Hoffman external fixation is more likely to cause abnormal healing of the articular surface.

Key words: bone, tibia, fracture, tibial plateau fracture, external fixation, internal fixation, meta-analysis, system evaluation

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