| 邵树宏,江起庭,冯明生.髌上入路与髌下入路胫骨髓内钉内固定术治疗胫骨干骨折临床疗效Meta分析[J].中国烧伤创疡杂志,2018,(2):. |
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| 摘要点击次数: 2297 |
| 全文下载次数: 4741 |
| 中文摘要: |
| 【摘要】 目的 采用Meta 分析评价经髌上入路和髌下入路行胫骨髓内钉内固定术治疗胫骨干骨折的临床疗效, 为胫骨髓内钉内固定术治疗胫骨干骨折手术路径的选择提供依据?方法 应用计算机检索PubMed?Cochrane Library?Embase?OVID?万方?维普?中国知网及中国生物医学文献数据库中有关髌上入路和髌下入路胫骨髓内钉内固定术治疗胫骨干骨折临床疗效对比分析的相关中英文文献, 并严格按照标准筛选及提取相关资料进行Meta分析, 对比两种术式在手术时间?术中出血量?术中透视时间?骨折愈合时间?Lysholm 膝关节评分?HSS 膝关节评分?术后膝关节疼痛方面的差异有无统计学意义?结果 按照检索策略共检索出307 篇文献, 经筛选后最终纳入符合各项标准的文献8 篇, 其中英文文献4 篇, 中文文献4 篇; 共纳入患者604 例, 其中髌上入路治疗组305 例, 髌下入路治疗组299 例?Meta 分析结果显示, 髌上入路治疗组患者的手术时间明显短于髌下入路治疗组[WMD = -2.08, 95%CI ( -3.45, -7.0), P <0.05], Lysholm 膝关节评分明显高于髌下入路治疗组[WMD =8.25, 95% CI (6.73, 9.78), P < 0.05], HSS 膝关节评分明显高于髌下入路治疗组[WMD = 6.80, 95% CI(4.78, 8.22), P <0.05], 术后膝关节疼痛例数明显少于髌下入路治疗组[OR = 0.35, 95% CI (0.21, 0.56),P <0.05], 差异具有统计学意义; 髌上入路治疗组患者的术中失血量与髌下入路治疗组患者的术中失血量基本相同[WMD = -0.79, 95%CI ( -2.80, -1.23), P >0.05], 术中透视时间与髌下入路治疗组患者的术中透视时间基本相同[WMD = -24.28, 95%CI ( -56.49, 7.93), P >0.05], 骨折愈合时间与髌下入路治疗组患者的骨折愈合时间基本相同[WMD =3.22, 95%CI ( -3.46, 9.90), P >0.05], 差异无统计学意义?结论 与髌下入路胫骨髓内钉内固定术治疗胫骨干骨折相比, 髌上入路胫骨髓内钉内固定术的临床疗效较为显著, 可有效缩短手术时间, 提高术后膝关节功能评分, 减少术后膝关节疼痛发生率? |
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| 【Abstract】 Objective To evaluate the clinical effect of suprapatellar? and infrapatellar?approach internal fixation of tibial intramedullary nailing in the treatment of tibial shaft fracture, with the purpose of providing evidence for choosing internal fixation routines of tibial intramedullary nailing for tibial shaft fracture. Methods Computer search was performed in databases including Pubmed, Cochrane Library, Embase, OVID, Wanfang Data, VIP Data, CNKI and CBMdisc for relevant Chinese and English literature comparing the clinical effects of suprapatellar- and infrapatellar?approach internal fixation of tibial intramedullary nailing in the treatment of tibial shaft fracture. Meta analysis was conducted on the data screened and extracted strictly according to inclusion standards. Comparison between the two approaches were done in terms of operation duration, intraoperative bleeding volume, intraoperative fluoroscopy time, fracture healing time, Lysholm knee score, HSS knee score and postoperative knee pain to study whether there is any statistically significant difference. Results A total of 307 papers were retrieved according to retrieving standards, but 8 papers completely met the inclusion standards, in which 4 were in Chinese and the other 4 were in English. A total of 604 patients were included into the study, in which 305 patients were in suprapatellar-approach (suprapatellar group) while 299 were in infrapatellar?approach (infrapatellar group). Meta analysis showed that the operation duration in the suprapatellar group was markedly shorter than that in the infrapatellar group [WMD = -2.08, 95%CI ( -3.45, -7.0), P <0.05]; Lysholm knee score and HSS knee score in the suprapatellar group were markedly higher than that in the infrapatellar group, respectively [WMD =8.25, 95%CI (6.73, 9.78),P <0.05] and [WMD =6.80, 95%CI (4.78, 8.22), P < 0.05]. Case number of patients suffering postoperative knee pain in the suprapatellar group were markedly less than that in the infrapatellar group [OR =0.35, 95%CI (0.21, 0.56),P <0.05]. Intraoperative bleeding volume, intraoperative fluoroscopy time and fracture healing time in the suprapatellar
group were basically the same as that in the infrapatellar group, respectively [ WMD = - 0.79, 95% CI ( - 2.80,-1.23), P >0.05], [WMD = - 24.28, 95% CI ( - 56.49, 7.93), P > 0.05], [WMD = 3.22, 95% CI ( - 3.46,9.90), P >0.05], without statistical significance. Conclusion Compared with the infrapatellar approach, the clinical efficacy of the suprapatellar approach internal fixation of tibial intramedullary nailing in the treatment of tibial shaft fracture is much better in terms of shorter operation duration, higher postoperative knee function score and less occurrence rate of postoperative knee pain. |
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