Gao Zhixue, Han Wei, Jia Haigang
Comprehensive Surgery, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital Traumatology Department, Beijing Ji Shui Tan Hospital Joint Surgery, Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing 100048, P.R. China.
Medicine (Baltimore). 2018 Jun;97(24):e10917. doi: 10.1097/MD.0000000000010917.
The aim of this study was to compare the outcome of using tibial nails inserted by the suprapatellar approach with tibial nails inserted by the infrapatellar approach in a meta-analysis of randomized controlled trials (RCTs).
The following electronic databases were searched: PubMed (1966 to January 2018), EMBASE (1974 to January 2018), Cochrane Library (January 2018), Web of Science (1990 to January 2018). We also used Google Search Engine to search more potentially eligible studies until January 2018. The methodological qualities of included studies were assessed in accordance with the guidelines provided by the Cochrane Collaboration for Systematic Reviews. The statistical analysis all of included studies were performed by STATA 13.0 software. The outcomes were total blood loss, postoperative pain, range of motion (ROM), Lysholm knee score, fluoroscopy time, operation time, and postoperative complications.
Four RCTs published between 2015 and 2017 were selected in the meta-analysis. There was a significant difference between suprapatellar and infrapatellar approach surgery in total blood loss, postoperative pain, ROM, Lysholm knee scores, and fluoroscopy times.
The suprapatellar approach for intramedullary nailing appears superior to the infrapatellar approach, with a reduction in total blood loss, improved postoperative pain, shorter fluoroscopy time, and better knee functionality outcomes. There was no increased incidence of postoperative complications between the 2 groups. Further research remains necessary.
本研究旨在通过对随机对照试验（RCT）的荟萃分析，比较经髌上入路插入胫骨钉与经髌下入路插入胫骨钉的疗效。
检索了以下电子数据库：PubMed（1966年至2018年1月）、EMBASE（1974年至2018年1月）、Cochrane图书馆（2018年1月）、科学网（1990年至2018年1月）。我们还使用谷歌搜索引擎搜索更多潜在符合条件的研究，直至2018年1月。根据Cochrane协作网系统评价指南评估纳入研究的方法学质量。所有纳入研究的统计分析均使用STATA 13.0软件进行。观察指标包括总失血量、术后疼痛、活动范围（ROM）、Lysholm膝关节评分、透视时间、手术时间和术后并发症。
荟萃分析选取了2015年至2017年间发表的4项RCT。髌上入路与髌下入路手术在总失血量、术后疼痛、ROM、Lysholm膝关节评分和透视时间方面存在显著差异。
髓内钉固定的髌上入路似乎优于髌下入路，可减少总失血量，改善术后疼痛，缩短透视时间，并获得更好的膝关节功能结果。两组术后并发症发生率均未增加。仍有必要进行进一步研究。
