Zhang Yinwang, Xu Zhen, Zhong Wuxue, Liu Fuhai, Tang Jie
Department of Orthopedics, Shanghai Xuhui District Central Hospital, No.966, Middle Huaihai Road, Shanghai, 200031, China.
J Orthop Surg Res. 2018 Sep 5;13(1):226. doi: 10.1186/s13018-018-0919-6.
To compare the efficacy and safety of K-wire tension band fixation (KTB) with other alternative approaches (cannulated screws, cable pin, and ring pin) for treatment of patella fractures by performing a meta-analysis.
PubMed and EMBASE databases were searched for all relevant studies. Standardized mean difference (SMD) or relative risk (RR) and their corresponding 95% confidence intervals (CIs) were calculated for continuous or dichotomous outcomes via either a fixed- or random-effect model using Stata 13.0 software.
Nine literatures involving 949 patients (581 in the KTB group and 368 in the control group) were included. Pooled analysis showed there were no differences in the success rate, operative time, healing time, and number of infections between patients undergoing KTB and others. However, the incidence of complications (RR = 8.04, 95% CI = 4.45-14.53; p < 0.001) and VAS (SMD = 0.642, 95% CI = 0.22-1.06; p = 0.003) were lower, while flexion degree (SMD = - 0.70 95% CI = - 1.04-- 0.36; p < 0.001), Böstman joint function score (SMD = - 0.68, 95% CI = - 1.10-- 0.27; p = 0.001), Iowa knee score (RR = 0.88, 95% CI = 0.81-0.96; p = 0.004), and Lysholm score (SMD = - 0.71, 95% CI = - 1.10-- 0.32; p < 0.001) were significantly higher in patients undergoing alternative approaches than the KTB. Subgroup analysis also demonstrated the cannulated screw fixation was superior to KTB in reducing the incidence of complications.
Alternative treatments may be effective for management of patella fractures and should be attempted to be popularized in clinic.
通过进行荟萃分析，比较克氏针张力带固定术（KTB）与其他替代方法（空心螺钉、缆钉和环形针）治疗髌骨骨折的疗效和安全性。
在PubMed和EMBASE数据库中检索所有相关研究。使用Stata 13.0软件，通过固定效应模型或随机效应模型，对连续或二分结局计算标准化均数差（SMD）或相对危险度（RR）及其相应的95%置信区间（CI）。
纳入9篇文献，共949例患者（KTB组581例，对照组368例）。汇总分析显示，接受KTB治疗的患者与接受其他治疗的患者在成功率、手术时间、愈合时间和感染例数方面无差异。然而，替代方法组患者的并发症发生率（RR = 8.04，95%CI = 4.45 - 14.53；p < 0.001）和视觉模拟评分（VAS，SMD = 0.642，95%CI = 0.22 - 1.06；p = 0.003）较低，而屈曲度（SMD = -0.70，95%CI = -1.04 - -0.36；p < 0.001）、Böstman关节功能评分（SMD = -0.68，95%CI = -1.10 - -0.27；p = 0.001）、Iowa膝关节评分（RR = 0.88，95%CI = 0.81 - 0.96；p = 0.004）和Lysholm评分（SMD = -0.71，95%CI = -1.10 - -0.32；p < 0.001）显著高于KTB组。亚组分析还表明，空心螺钉固定在降低并发症发生率方面优于KTB。
替代治疗方法可能对髌骨骨折的治疗有效，应尝试在临床中推广。
