CAJ | 학술논문

目的：系统评价我国小切口复位内固定术（MIPPO）与切开复位内固定治疗胫骨远端骨折的疗效与安全性。方法计算机检索中国知网（CNKI：2003年9月-2013年5月）、万方数据库（2003年9月-2013年5月）、维普数据库（2003年9月-2013年5月），中国生物医学数据库及超星电子图书。手工检索国内近五年来发表于《中华骨科杂志》、《中国矫形外科杂志》及《临床骨科杂志》等各骨科杂志及相关杂志的相关文献。收集所有相关 MIPPO与切开复位内固定治疗胫骨远端骨折的随机对照试验及半随机对照试验，采用 Cochrane协作网提供的软件 RevMan5．0进行系统评价。结果共纳入12篇随机对照试验及半随机对照试验，共733例患者，纳入研究质量评价结果为 B级10篇，C级2篇。系统评价结果显示，与切开复位内固定组相比，MIPPO 组术中失血量少[SMD＝-4．46，95％CI（-5．87，-3．05），P ＜0．05]；骨折愈合时间短[SMD＝-1．54，95％CI（-2．02，-1．06），P＜0．05]；术后优良率高[RR＝1．22，95％CI（1．13，1．32），P ＜0．05]，但两组手术时间比较差异无统计学意义。结论采用 MIPPO术治疗胫骨远端骨折具有明显的优势，值得临床推广。但由于该系统评价尚存在一定的局限性，故需要大量严格的、大样本量的、多中心性的，并且采用正确的随机、盲法、分配隐藏以及对失访与退出的患者进行正确的意向性分析（ITT分析）等文献研究来进一步论证。
목적：계통평개아국소절구복위내고정술（MIPPO）여절개복위내고정치료경골원단골절적료효여안전성。방법계산궤검색중국지망（CNKI：2003년9월-2013년5월）、만방수거고（2003년9월-2013년5월）、유보수거고（2003년9월-2013년5월），중국생물의학수거고급초성전자도서。수공검색국내근오년래발표우《중화골과잡지》、《중국교형외과잡지》급《림상골과잡지》등각골과잡지급상관잡지적상관문헌。수집소유상관 MIPPO여절개복위내고정치료경골원단골절적수궤대조시험급반수궤대조시험，채용 Cochrane협작망제공적연건 RevMan5．0진행계통평개。결과공납입12편수궤대조시험급반수궤대조시험，공733례환자，납입연구질량평개결과위 B급10편，C급2편。계통평개결과현시，여절개복위내고정조상비，MIPPO 조술중실혈량소[SMD＝-4．46，95％CI（-5．87，-3．05），P ＜0．05]；골절유합시간단[SMD＝-1．54，95％CI（-2．02，-1．06），P＜0．05]；술후우량솔고[RR＝1．22，95％CI（1．13，1．32），P ＜0．05]，단량조수술시간비교차이무통계학의의。결론채용 MIPPO술치료경골원단골절구유명현적우세，치득림상추엄。단유우해계통평개상존재일정적국한성，고수요대량엄격적、대양본량적、다중심성적，병차채용정학적수궤、맹법、분배은장이급대실방여퇴출적환자진행정학적의향성분석（ITT분석）등문헌연구래진일보론증。
Objective Systematicly reviewing of MIPPO with open reduction and internal fixation of distal tibial fracture efficacy and safety.Methods We searched for all randomized controlled and quasi-random-ized controlled trials of MIPPO and open reduction and internal fixation for the treatment of distal tibial fractures of patients by electronically searching CNKI (2003.9-2013.5),WANFANG (2003.9-201 3.5), VIP(2003.9-2013.5),CBM,CHAOXING.We handsearched domestic literature published in orthopedic journals and related magazines in the past five years:China Journal of Orthopaedics Series,Orthopaedic Journal of China,Journal of Clinical Orthopaedics,etc.The Revman5.0 provided by the Cochrane Collabo-ration was used for management and analysis.Results 1 2 randomized controlled and quasi-Randomized controlled were included.733 patients,Evaluation results for the quality of included studiesshow 12 B grade,2 C grade.System evaluation results show that less blood loss in the MIPPO group compared with the open reduction and internal fixation group[SMD=-4.46,95%CI (-5.87,-3.05),P <0.05];frac-ture healing time is short [SMD=-1.54,95%CI (-2.02,-1.06),P <0.05];postoperative excellent rate [RR = 1.22,95%CI(1.13,1.32),P < 0.05 ], but no significant difference in ope-rative time. Conclusion Using MIPPO treatment of distal tibial fractures has obvious advantages,worthy of promo-tion.However,due to the systematic review are still some limitations,it requires a lot of rigorous,large sample volume,multi-center,and with the right randomized,blinded,allocation concealment and right and exit of patients lost to follow correct ITT analysis,literature studies further demonstrated.