中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
22期
4107-4114
,共8页
骨关节植入物%骨与关节循证医学%骨科植入物%交锁髓内钉%微创经皮钢板%胫骨中下段骨折%Meta分析%骨不连%微创内固定%骨折愈合%生物学固定
骨關節植入物%骨與關節循證醫學%骨科植入物%交鎖髓內釘%微創經皮鋼闆%脛骨中下段骨摺%Meta分析%骨不連%微創內固定%骨摺愈閤%生物學固定
골관절식입물%골여관절순증의학%골과식입물%교쇄수내정%미창경피강판%경골중하단골절%Meta분석%골불련%미창내고정%골절유합%생물학고정
背景:临床中治疗成人胫骨中下段骨折的微创内固定方式包括交锁髓内钉技术和微创经皮钢板技术.大量回顾性研究都证实这两种策略临床有效,但两种治疗方法孰优孰劣,目前仍无定论.目的:评价交锁髓内钉技术与微创经皮钢板技术治疗成人胫骨中下段骨折的临床疗效差异.方法:计算机检索PubMed、Embase、Cochrane、CBM、万方、CNKI数据库中比较交锁髓内钉与微创经皮钢板治疗成人胫骨中下段骨折的文章,并手工检索相关中英文杂志,纳入随机对照试验和半随机对照试验.然后,按照Cochrane Col aboration标准对相关文献进行严格的质量评估,选取手术时间、骨折愈合时间、骨组织愈合相关不良事件、软组织愈合相关不良事件、胫骨功能恢复作为评价指标,并用RevMan 5.1统计学软件对结果进行Meta分析.结果与结论:共纳入7篇文献,包括377例患者,其中交锁髓内钉组188例,微创经皮钢板组189例.Meta 分析结果显示:在治疗胫骨中下段骨折的比较中,两种方法在手术时间[WMD=0.58,95%CI(-28.91,30.07),P=0.97]、软组织相关不良事件发生率[RR=0.51,95%CI(0.22,1.18),P=0.11]及胫骨术后 Johnner-Wruhs 功能评价优良率[RR=1.03,95%CI(0.91,1.17),P=0.63]等方面差异无显著性意义;而相比于交锁髓内钉组,微创经皮钢板组骨折愈合时间较短[WMD=1.99,95%CI(0.15,3.83), P=0.03],骨组织愈合相关不良事件发生率较低[RR=1.84,95%CI(1.03,3.27),P=0.04].说明利用交锁髓内钉和微创经皮钢板治疗成人胫骨中下段骨折的疗效基本一致,但微创经皮钢板可缩短患者骨折愈合时间,减少骨折愈合相关不良事件的发生.
揹景:臨床中治療成人脛骨中下段骨摺的微創內固定方式包括交鎖髓內釘技術和微創經皮鋼闆技術.大量迴顧性研究都證實這兩種策略臨床有效,但兩種治療方法孰優孰劣,目前仍無定論.目的:評價交鎖髓內釘技術與微創經皮鋼闆技術治療成人脛骨中下段骨摺的臨床療效差異.方法:計算機檢索PubMed、Embase、Cochrane、CBM、萬方、CNKI數據庫中比較交鎖髓內釘與微創經皮鋼闆治療成人脛骨中下段骨摺的文章,併手工檢索相關中英文雜誌,納入隨機對照試驗和半隨機對照試驗.然後,按照Cochrane Col aboration標準對相關文獻進行嚴格的質量評估,選取手術時間、骨摺愈閤時間、骨組織愈閤相關不良事件、軟組織愈閤相關不良事件、脛骨功能恢複作為評價指標,併用RevMan 5.1統計學軟件對結果進行Meta分析.結果與結論:共納入7篇文獻,包括377例患者,其中交鎖髓內釘組188例,微創經皮鋼闆組189例.Meta 分析結果顯示:在治療脛骨中下段骨摺的比較中,兩種方法在手術時間[WMD=0.58,95%CI(-28.91,30.07),P=0.97]、軟組織相關不良事件髮生率[RR=0.51,95%CI(0.22,1.18),P=0.11]及脛骨術後 Johnner-Wruhs 功能評價優良率[RR=1.03,95%CI(0.91,1.17),P=0.63]等方麵差異無顯著性意義;而相比于交鎖髓內釘組,微創經皮鋼闆組骨摺愈閤時間較短[WMD=1.99,95%CI(0.15,3.83), P=0.03],骨組織愈閤相關不良事件髮生率較低[RR=1.84,95%CI(1.03,3.27),P=0.04].說明利用交鎖髓內釘和微創經皮鋼闆治療成人脛骨中下段骨摺的療效基本一緻,但微創經皮鋼闆可縮短患者骨摺愈閤時間,減少骨摺愈閤相關不良事件的髮生.
배경:림상중치료성인경골중하단골절적미창내고정방식포괄교쇄수내정기술화미창경피강판기술.대량회고성연구도증실저량충책략림상유효,단량충치료방법숙우숙렬,목전잉무정론.목적:평개교쇄수내정기술여미창경피강판기술치료성인경골중하단골절적림상료효차이.방법:계산궤검색PubMed、Embase、Cochrane、CBM、만방、CNKI수거고중비교교쇄수내정여미창경피강판치료성인경골중하단골절적문장,병수공검색상관중영문잡지,납입수궤대조시험화반수궤대조시험.연후,안조Cochrane Col aboration표준대상관문헌진행엄격적질량평고,선취수술시간、골절유합시간、골조직유합상관불량사건、연조직유합상관불량사건、경골공능회복작위평개지표,병용RevMan 5.1통계학연건대결과진행Meta분석.결과여결론:공납입7편문헌,포괄377례환자,기중교쇄수내정조188례,미창경피강판조189례.Meta 분석결과현시:재치료경골중하단골절적비교중,량충방법재수술시간[WMD=0.58,95%CI(-28.91,30.07),P=0.97]、연조직상관불량사건발생솔[RR=0.51,95%CI(0.22,1.18),P=0.11]급경골술후 Johnner-Wruhs 공능평개우량솔[RR=1.03,95%CI(0.91,1.17),P=0.63]등방면차이무현저성의의;이상비우교쇄수내정조,미창경피강판조골절유합시간교단[WMD=1.99,95%CI(0.15,3.83), P=0.03],골조직유합상관불량사건발생솔교저[RR=1.84,95%CI(1.03,3.27),P=0.04].설명이용교쇄수내정화미창경피강판치료성인경골중하단골절적료효기본일치,단미창경피강판가축단환자골절유합시간,감소골절유합상관불량사건적발생.
@@@@BACKGROUND: The invasive internal fixation method for the treatment of middle and distal tibial fracture includes interlocking intramedul ary nail and minimal y invasive percutaneous plate osteosynthesis in clinic. A large number of retrospective studies have confirmed the effectiveness of these two strategies, but there is stil no conclusion in which one is better. OBJECTIVE: To compare clinical outcomes of interlocking intramedul ary nail s and minimal y invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults. METHODS: The PubMed database, Embase database, Cochrane database, CBM database, Wangfang database and CNKI database were searched by computer for the articles on interlocking intramedul ary nail s and minimal y invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults, and the relevant Chinese and English orthopedic journals were hand-searched, including randomized control ed trials and quasi-randomized control ed trials. Then, the retrieved studies were strictly evaluated in accordance with the Cochrane Col aboration criteria, and the evaluation index included operation time, fracture healing time, bone tissue healing-related adverse events, soft tissue healing-related adverse events and tibia functional recovery. Meta-analysis was performed using RevMan 5.1 software. RESULTS AND CONCLUSION: A total of 7 articles were screened out, including 377 patients, 188 cases in the interlocking intramedul ary nail group and 189 in the minimal y invasive percutaneous plate osteosynthesis group. The results of meta-analysis showed that there were no statistical y significant differences in the operation time [weighted mean difference=0.58, 95% confidence interval (-28.91, 30.07), P=0.97], the incidence of bone tissue healing-related adverse events [relative risk=0.51, 95% confidence interval (0.22, 1.18), P=0.11], and excel ent and good rate of postoperative Johnner-Wruhs function evaluation [relative risk =1.03, 95% confidence interval (0.91, 1.17), P=0.63] between two groups. However, compared with interlocking intramedul ary nail group, the fracture healing time was shorter in the minimal y invasive percutaneous plate group [weighted mean difference=1.99, 95% confidence interval (0.15, 3.83), P=0.03], and the incidence of bone tissue healing-related adverse events was lower [relative risk=1.84, 95% confidence interval (1.03, 3.27), P=0.04]. The results indicate that the Interlocking intramedul ary nail and minimal y invasive percutaneous plate osteosynthesis has the same effect in the treatment of middle and distal tibial fracture in adults, but minimal y invasive percutaneous plate osteosynthesis can shorten the healing time and reduce the incidence of bone tissue healing-related adverse events.
