Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Injury. 2020 Oct;51(10):2259-2266. doi: 10.1016/j.injury.2020.07.003. Epub 2020 Jul 3.
Whether plate fixation or sacroiliac (SI) screw fixation is the better treatment for posterior pelvic ring disruption is controversial. The aim of this systematic review and meta-analysis was to compare the two fixation methods.
The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies comparing plate and SI screw fixations in posterior pelvic ring injuries. Intraoperative variables, postoperative complications, and clinical/radiological scores were compared between the techniques.
Eleven studies were included in the qualitative synthesis, and nine in the meta-analysis. The meta-analysis included 202 patients who underwent plate fixation and 258 patients who underwent SI screw fixation. The incision length and mean blood loss were greater in the plate group than in the SI screw group (standard mean difference (SMD) = 7.29, 95% confidence interval (CI): 3.18-11.40; SMD = 5.09, 95% CI: 2.08-8.09, respectively). Patients in the SI screw group had more X-ray exposure than those in the plate group (SMD = -5.96, 95% CI: -7.95-3.97). There were no differences in operation time and intraoperative complications (SMD = -1.42, 95% CI: -3.90-1.05; OR = 0.92, 95% CI: 0.05-18.60, respectively). The duration of hospital stay was longer in the plate group (SMD = 2.21, 95% CI: 1.74-2.68). There were no differences in postoperative neurological complications, infection rate, and nonunion rate (OR = 1.62, 95% CI: 0.20-13.21; OR = 2.10, 95% CI: 0.74-5.94; OR = 1.12, 95% CI: 0.26-4.87, respectively), but implant loosening was more common in the SI screw group (OR = 0.18, 95% CI: 0.04-0.87). There was no difference in revision surgery (OR = 0.23, 95% CI: 0.02-2.14). The total excellent rating according to the postoperative Majeed functional and Matta scores was higher in the SI screw group (OR = 0.43, 95% CI: 0.20-0.91; OR = 0.24, 95% CI: 0.08-0.74, respectively).
SI screw fixation was superior to plate fixation in the functional and radiological scores, but implant loosening was more common for the treatment posterior pelvic ring injuries.
对于骨盆后环破裂，钢板固定还是骶髂螺钉固定是更好的治疗方法，目前仍存在争议。本系统评价和荟萃分析的目的是比较这两种固定方法。
系统检索 MEDLINE、Embase 和 Cochrane 图书馆数据库，以比较后路骨盆环损伤中钢板和骶髂螺钉固定的研究。比较两种技术的术中变量、术后并发症和临床/影像学评分。
定性综合纳入 11 项研究，荟萃分析纳入 9 项研究。荟萃分析纳入 202 例行钢板固定的患者和 258 例行骶髂螺钉固定的患者。钢板组的切口长度和平均失血量大于骶髂螺钉组（标准化均数差（SMD）=7.29，95%置信区间（CI）：3.18-11.40；SMD=5.09，95%CI：2.08-8.09）。骶髂螺钉组的 X 射线暴露量多于钢板组（SMD=-5.96，95%CI：-7.95-3.97）。手术时间和术中并发症无差异（SMD=-1.42，95%CI：-3.90-1.05；OR=0.92，95%CI：0.05-18.60）。钢板组的住院时间较长（SMD=2.21，95%CI：1.74-2.68）。术后神经并发症、感染率和不愈合率无差异（OR=1.62，95%CI：0.20-13.21；OR=2.10，95%CI：0.74-5.94；OR=1.12，95%CI：0.26-4.87），但骶髂螺钉组的植入物松动更为常见（OR=0.18，95%CI：0.04-0.87）。翻修手术无差异（OR=0.23，95%CI：0.02-2.14）。根据术后 Majeed 功能和 Matta 评分，骶髂螺钉组的总优良率更高（OR=0.43，95%CI：0.20-0.91；OR=0.24，95%CI：0.08-0.74）。
对于骨盆后环损伤，骶髂螺钉固定在功能和影像学评分方面优于钢板固定，但植入物松动更为常见。
