Kwok Chun Shing, Crossman Paul T, Loizou Constantinos L
Department of Trauma and Orthopaedics, Ipswich Hospital NHS Trust, Suffolk, United Kingdom.
J Orthop Trauma. 2014 Sep;28(9):542-8. doi: 10.1097/BOT.0000000000000068.
To undertake a systematic review to determine whether there are advantages in using plate or nail fixation for distal meta-diaphyseal tibial fractures with or without articular involvement.
Searches using MEDLINE, EMBASE, and Cochrane library.
Studies of parallel group design comparing plate or nail fixation for distal tibial fractures.
Information on study methods and outcomes.
We conducted random effects meta-analysis to evaluate risk of nonunion or delayed union, wound complications and superficial infection, deep infection, and fracture malalignment.
We found 8 studies (n = 455, 4 prospective randomized and 4 retrospective cohort) that evaluated plate compared with nail for distal tibial fractures. No significant difference was found between the use of a plate and nail regarding bone union complications [plate, 5.4%; nail, 8.3%; odds ratio (OR), 0.66; 95% confidence interval (CI), 0.28-1.54; I = 0%; P = 0.34], wound complications including superficial infection (plate, 7.9%; nail, 3.2%; OR, 1.83; 95% CI, 0.40-8.46; I = 48%; P = 0.44), and deep infection (plate, 3.5%; nail, 2.8%; OR, 1.32; 95% CI, 0.44-3.91; I = 0%; P = 0.62). We found a significantly reduced risk of fracture malalignment with the use of a plate compared with a nail (plate, 8.7%; nail, 24.9%; OR, 0.33; 95% CI, 0.17-0.64; I = 0%; P = 0.001).
Plate fixation compared with intramedullary nailing is associated with a reduced risk of fracture malalignment with no differences in bone union, wound complications, and superficial infection or deep infection. Current evidence might recommend plate over nail unless there are concerns with the soft tissues. Additional larger scale multicentre randomized controlled trials are required to clarify these issues.
进行一项系统评价，以确定对于伴有或不伴有关节受累的胫骨干骺端远端骨折，使用钢板或髓内钉固定是否存在优势。
使用MEDLINE、EMBASE和Cochrane图书馆进行检索。
比较钢板或髓内钉固定治疗胫骨干骺端远端骨折的平行组设计研究。
关于研究方法和结果的信息。
我们进行随机效应荟萃分析，以评估骨不连或延迟愈合、伤口并发症和浅表感染、深部感染以及骨折畸形的风险。
我们发现8项研究（n = 455，4项前瞻性随机研究和4项回顾性队列研究）比较了钢板与髓内钉治疗胫骨干骺端远端骨折的效果。在骨愈合并发症方面，钢板和髓内钉的使用之间没有显著差异[钢板，5.4%；髓内钉，8.3%；比值比（OR），0.66；95%置信区间（CI），0.28 - 1.54；I² = 0%；P = 0.34]，在包括浅表感染的伤口并发症方面（钢板，7.9%；髓内钉，3.2%；OR，1.83；95% CI，0.40 - 8.46；I² = 48%；P = 0.44），以及深部感染方面（钢板，3.5%；髓内钉，2.8%；OR，1.32；95% CI，0.44 - 3.91；I² = 0%；P = 0.62）。我们发现与髓内钉相比，使用钢板时骨折畸形的风险显著降低（钢板，8.7%；髓内钉，24.9%；OR，0.33；95% CI，0.17 - 0.64；I² = 0%；P = 0.001）。
与髓内钉固定相比，钢板固定与骨折畸形风险降低相关，在骨愈合、伤口并发症以及浅表感染或深部感染方面没有差异。除非存在软组织方面的担忧，当前证据可能推荐使用钢板而非髓内钉。需要更多大规模的多中心随机对照试验来阐明这些问题。
