一项比较外固定与切开复位内固定治疗胫骨平台骨折的Meta分析。
A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures.
作者信息
Naja Ahmad S, Bouji Nour, Eddine Mohamad Nasser, Alfarii Humaid, Reindl Rudolf, Tfayli Yehia, Issa Mohamad, Saghieh Said
机构信息
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Clinical and Translational Science Institute, West Virginia University, Morgantown, West Virginia, United States of America.
出版信息
Strategies Trauma Limb Reconstr. 2022 May-Aug;17(2):105-116. doi: 10.5005/jp-journals-10080-1557.
AIM
This article aims to compare the outcomes between open reduction and internal fixation (ORIF) and external fixation (ExFix) in tibial plateau fractures.
BACKGROUND
Open reduction and internal fixation and external fixation are common methods for managing tibial plateau fractures without a consensus of choice.
MATERIALS AND METHODS
PubMed, Cochrane Library, Ovid, CINAHL®, Scopus, and Embase were searched. Clinical studies in humans comparing ExFix and ORIF for tibial plateau fractures were included. Case reports, pathological, and biomechanical studies were excluded. Two investigators reviewed the studies independently, and any discrepancies were resolved. The quality and heterogeneity of each study were assessed in addition to calculating the odds ratio (OR) of the surgical outcomes and complications at a 95% confidence interval, with <0.05 as statistical significance.
RESULTS
Of the 14 included studies, one was a randomised trial, one was a prospective study, and 12 were retrospective studies. The 865 fractures identified across the studies constituted 458 (52.9%) in the ExFix group and 407 (47.1%) in the ORIF group. Most studies indicated a better outcome for ORIF as compared to ExFix. Open reduction and internal fixation had a lower incidence of superficial infection and postoperative osteoarthritis, while ExFix revealed a lower proportion with heterotopic ossification (HTO).
CONCLUSION
ExFix has a higher rate of superficial infections and osteoarthritis, whereas ORIF has a higher incidence of HTO. Larger studies are needed to compare outcomes and investigate the findings of this study further.
CLINICAL SIGNIFICANCE
This up-to-date meta-analysis on tibial plateau management will help surgeons make evidence-based decisions regarding the use of ORIF versus ExFix.
HOW TO CITE THIS ARTICLE
Naja AS, Bouji N, Eddine MN, . A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures. Strategies Trauma Limb Reconstr 2022;17(2):105-116.
目的
本文旨在比较切开复位内固定术（ORIF）与外固定术（ExFix）治疗胫骨平台骨折的疗效。
背景
切开复位内固定术和外固定术是治疗胫骨平台骨折的常用方法，但在选择上尚未达成共识。
材料与方法
检索了PubMed、Cochrane图书馆、Ovid、CINAHL®、Scopus和Embase。纳入比较外固定术和切开复位内固定术治疗胫骨平台骨折的人体临床研究。排除病例报告、病理学和生物力学研究。两名研究者独立审查这些研究，任何分歧都得到了解决。除了计算手术结果和并发症的优势比（OR）（95%置信区间）外，还评估了每项研究的质量和异质性，以P<0.05为具有统计学意义。
结果
在纳入的14项研究中，1项为随机试验，1项为前瞻性研究，12项为回顾性研究。各研究中确定的865例骨折，外固定术组458例（52.9%），切开复位内固定术组407例（47.1%）。大多数研究表明，与外固定术相比，切开复位内固定术的疗效更好。切开复位内固定术的浅表感染和术后骨关节炎发生率较低，而外固定术的异位骨化（HTO）发生率较低。
结论
外固定术的浅表感染和骨关节炎发生率较高，而切开复位内固定术的异位骨化发生率较高。需要开展更大规模的研究来比较疗效，并进一步调查本研究的结果。
临床意义
这项关于胫骨平台治疗的最新荟萃分析将有助于外科医生就是采用切开复位内固定术还是外固定术做出循证决策。
如何引用本文
纳贾·阿斯、布吉·纳、埃丁·姆南等。一项比较外固定与切开复位内固定治疗胫骨平台骨折的荟萃分析。《创伤肢体重建策略》2022年；17（2）：105 - 116。
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