The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China; Tianjin Medical University, Tianjin 30070, People's Republic of China.
The Orthopaedic Institute, Tianjin Hospital, Tianjin 300050, People's Republic of China.
Int J Surg. 2017 Mar;39:65-73. doi: 10.1016/j.ijsu.2017.01.044. Epub 2017 Jan 12.
Both external fixation (ExFx) and open reduction and internal fixation(ORIF) were used to treat complex tibial plateau fractures, but it was not sure which one was better. So we did this meta-analysis to evaluate the outcomes of ExFx and ORIF in managing complex tibial plateau fractures.
Articles published before August 5, 2016 were selected from PubMed, Cochrane library, and some other electronic database. Relevant journals were also searched manually with no language limited. Two independent reviewers searched and assessed the literature. A fixed effect model was initially used for meta-analyses with RevMan 5.3.
When compared with ORIF, cases undergoing ExFx were more likely to return to the preinjury state at the early stage, but no difference in the later period of follow-up. However, ExFx group had higher infection rate (OR 1.98, 95% CI 1.08-3.63, P = 0.03), higher venous thromboembolism rate (OR 1.56, 95% CI 0.49-4.96, P = 0.45), higher re-operation rate (OR 0.87, 95% CI 0.47-1.62, P = 0.66) and lower compartment syndrome rate (OR 0.61, 95% CI 0.12-3.22, P = 0.56), lower TKA rate (OR 0.51, 95% CI 0.20-1.34, P = 0.17). There were no statistically significant differences in the rate of deep infection, venous thromboembolism, compartment syndrome and VTE between the two groups.
Although external fixation may offer some advantages, both were acceptable strategies in managing complex tibial plateau fractures. According to our analysis results, we strongly recommend that selection of definitive fixators should base on the fracture patterns, soft-tissue condition as well as the injury stages in clinical practice. More important, further multicentered, randomized controlled studies should be implemented to get a more reliable and clear result.
外固定架（ExFx）和切开复位内固定（ORIF）均用于治疗复杂胫骨平台骨折，但尚不确定哪种方法更好。因此，我们进行了这项荟萃分析，以评估 ExFx 和 ORIF 治疗复杂胫骨平台骨折的效果。
从 PubMed、Cochrane 图书馆和其他一些电子数据库中检索 2016 年 8 月 5 日前发表的文章。还手动检索了相关期刊，没有语言限制。两位独立的审查员搜索和评估了文献。最初使用固定效应模型进行荟萃分析，使用 RevMan 5.3 进行分析。
与 ORIF 相比，接受 ExFx 治疗的患者在早期更有可能恢复到受伤前的状态，但在随访后期则没有差异。然而，ExFx 组感染率更高（OR 1.98，95%CI 1.08-3.63，P=0.03），静脉血栓栓塞率更高（OR 1.56，95%CI 0.49-4.96，P=0.45），再次手术率更高（OR 0.87，95%CI 0.47-1.62，P=0.66），间隔综合征发生率更低（OR 0.61，95%CI 0.12-3.22，P=0.56），全膝关节置换术（TKA）率更低（OR 0.51，95%CI 0.20-1.34，P=0.17）。两组之间的深部感染、静脉血栓栓塞、间隔综合征和 VTE 发生率没有统计学差异。
虽然外固定架可能具有一些优势，但在治疗复杂胫骨平台骨折方面，两种方法都是可接受的策略。根据我们的分析结果，我们强烈建议在临床实践中，根据骨折类型、软组织状况和损伤阶段选择最终的固定器。更重要的是，应开展更多的多中心、随机对照研究，以获得更可靠和明确的结果。
