髌上与髌下单钉固定治疗胫骨骨折的疼痛、并发症发生率和临床结局差异？1447 例患者的系统评价。
Difference in Pain, Complication Rates, and Clinical Outcomes After Suprapatellar Versus Infrapatellar Nailing for Tibia Fractures? A Systematic Review of 1447 Patients.
机构信息
Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Orthopaedic Trauma Surgery, Cantonal Hospital Lucerne (LUKS), Lucerne, Switzerland.
出版信息
J Orthop Trauma. 2021 Aug 1;35(8):391-400. doi: 10.1097/BOT.0000000000002043.
OBJECTIVES
To assess the effectiveness of suprapatellar (SP)-nailing versus infrapatellar (IP)-nailing of tibia fractures in anterior knee pain, complications (retropatellar chondropathy, infection, and malalignment) and physical functioning and quality of life. A clinical question-driven and thorough systematic review of current literature is provided.
DATA SOURCE
PubMed and Embase databases were searched for studies published between 2010 and 2020 relating to SP and IP-nailing of tibia fractures. The study is performed in concordance with PRISMA-guidelines.
STUDY SELECTION
Studies eligible for inclusion were randomized controlled trials, prospective and retrospective observational studies reporting on outcomes of interest.
DATA EXTRACTION
Data extraction was performed independently by 2 assessors. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal.
DATA SYNTHESIS
Continuous variables are presented as means with SD and dichotomous variables as frequency and percentages. The weighted mean, standardized weighted mean differences, and 95% confidence interval were calculated. A pooled analysis could not be performed because of differences in outcome measures, time-points, and heterogeneity.
RESULTS
Fourteen studies with 1447 patients were analyzed. The weighted incidence of anterior knee pain was 29% after SP-nailing and 39% after IP-nailing, without reported significance. There was a significant lower rate of malalignment after the SP-approach (4% vs. 26%) with small absolute differences in all planes. No substantial differences were observed in retropatellar chondropathy, infection, physical functioning, and quality of life.
CONCLUSIONS
This systematic review does not reveal superiority of either technique in any of the respective outcomes of interest. Definitive choice should depend on the surgeon's experience and available resources.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
目的
评估髌上（SP）-钉与髌下（IP）-钉治疗胫骨骨折在膝关节前痛、并发症（髌前软骨病、感染和对线不良）以及身体功能和生活质量方面的效果。提供了一项基于临床问题的、对当前文献的全面系统评价。
数据来源
在 2010 年至 2020 年期间，在 PubMed 和 Embase 数据库中搜索了与 SP 和 IP 钉治疗胫骨骨折相关的研究。本研究符合 PRISMA 指南。
研究选择
纳入的研究为随机对照试验、前瞻性和回顾性观察研究，报告了相关结果。
数据提取
两名评估员独立进行数据提取。根据 McMaster 批判性评估指南评估方法学质量和偏倚风险。
数据综合
连续变量以平均值±标准差表示，二分类变量以频率和百分比表示。计算了加权平均值、标准化加权平均差和 95%置信区间。由于结局测量、时间点和异质性的差异，无法进行汇总分析。
结果
分析了 14 项研究共 1447 例患者。SP 钉固定后膝关节前痛的加权发生率为 29%，IP 钉固定后为 39%，但无统计学意义。SP 入路的对线不良发生率显著较低（4%对 26%），所有平面的绝对差异较小。髌前软骨病、感染、身体功能和生活质量无明显差异。
结论
本系统评价未显示两种技术在任何相关结局上具有优越性。最终选择应取决于外科医生的经验和可用资源。
证据水平
治疗性 II 级。欲了解完整的证据水平描述，请参见作者指南。
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