Department of Primary Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
J Orthop Surg Res. 2021 Aug 17;16(1):506. doi: 10.1186/s13018-021-02612-1.
Open reduction internal fixation (ORIF) has long been the conventional procedure for managing displaced patella fracture. This surgical approach has certain drawbacks, which might affect clinical outcomes and patient prognosis. Minimally invasive percutaneous fixation (MIPF) was proposed to overcome these disadvantages. Few in-depth investigations have been performed to determine the superiority of MIPF over ORIF. The aim of this study was to compare the efficacies of MIPF and ORIF for patella fractures.
The PubMed, Cochrane Library, Embase, and Scopus databases were searched for relevant studies from November 26 to December 17, 2020. Non-English publications and pediatric orthopedic articles were excluded. Statistical analysis was performed using Review Manager, version 5.4, with mean differences (MDs), standardized mean differences (SMDs), odds ratios (ORs), and respective 95% confidence intervals (CIs) calculated using a random effects model. The primary outcomes were the pain score, knee range of motion, and joint functionality. The secondary outcomes were the surgical time, complications, and implant removal rate.
Six articles with a total of 304 patients were included in the meta-analysis. Pooled analysis revealed that patients with MIPF had a significantly reduced pain score (MD = - 1.30, 95% CI = - 1.77 to -0.82; p < 0.00001) and increased knee extension angles (MD = 0.72, 95% CI = 0.18 to 1.25; p = 0.009) at 3-month follow-up. Furthermore, knee flexion angles (MD = 8.96, 95% CI = 5.81 to 12.1; p < 0.00001) and joint functionality (SMD = 0.54, 95% CI = 0.21 to 0.86; p = 0.001) had statistically improved at 2 years. However, no difference was observed between MIPF and ORIF with regard to the surgical time. The risk of complications (OR = 0.10, 95% CI = 0.05 to 0.18; p < 0.00001) and implant removal rate (OR = 0.20, 95% CI = 0.07 to 0.57; p = 0.003) were significantly lower with MIPF than with ORIF.
MIPF is more favorable than ORIF in terms of the pain score, knee range of motion, joint functionality, complications, and implant removal rate. Thus, it can be adopted as an alternative to ORIF.
切开复位内固定（ORIF）长期以来一直是治疗移位髌骨骨折的常规方法。这种手术方法有一定的缺点，可能会影响临床结果和患者预后。微创经皮固定（MIPF）的提出是为了克服这些缺点。很少有深入的研究来确定 MIPF 优于 ORIF。本研究旨在比较 MIPF 和 ORIF 治疗髌骨骨折的疗效。
检索了 2020 年 11 月 26 日至 12 月 17 日期间 PubMed、Cochrane Library、Embase 和 Scopus 数据库中相关研究。排除非英语出版物和儿科骨科文章。使用 Review Manager，版本 5.4 进行统计学分析，采用随机效应模型计算均值差（MD）、标准化均数差（SMD）、比值比（OR）和各自的 95%置信区间（CI）。主要结局是疼痛评分、膝关节活动范围和关节功能。次要结局是手术时间、并发症和植入物取出率。
共有 6 篇文章，总计 304 例患者纳入荟萃分析。汇总分析显示，MIPF 组患者疼痛评分明显降低（MD=-1.30，95%CI=-1.77 至-0.82；p<0.00001），膝关节伸展角度增加（MD=0.72，95%CI=0.18 至 1.25；p=0.009），在 3 个月随访时。此外，膝关节屈曲角度（MD=8.96，95%CI=5.81 至 12.1；p<0.00001）和关节功能（SMD=0.54，95%CI=0.21 至 0.86；p=0.001）在 2 年时也有统计学改善。然而，MIPF 和 ORIF 组在手术时间方面无差异。MIPF 组并发症（OR=0.10，95%CI=0.05 至 0.18；p<0.00001）和植入物取出率（OR=0.20，95%CI=0.07 至 0.57；p=0.003）的风险明显低于 ORIF 组。
与 ORIF 相比，MIPF 在疼痛评分、膝关节活动范围、关节功能、并发症和植入物取出率方面更具优势。因此，它可以作为 ORIF 的替代方法。
