Huang Daran, Teng Thomas Zheng Jie, Bin Abd Razak Hamid Rahmatullah
Department of Orthopaedic Surgery, Sengkang General Hospital, Medical Centre Level 9, 110 Sengkang East Way, 544886, Singapore.
J Clin Orthop Trauma. 2023 Dec 12;47:102314. doi: 10.1016/j.jcot.2023.102314. eCollection 2023 Dec.
This paper aims to systematically review and meta-analyse the available evidence regarding the clinical and radiographic outcomes of non-metal fixation methods in treating patellar fractures compared to a control metal fixation group, in the hopes of bringing insight into their effectiveness.
Two investigators systematically reviewed studies across 9 English or Mandarin electronic databases - Cochrane Library, EMBASE, Google Scholar, Medline, PubMed, Scopus, Web of Science, CNKI and Wanfang Data, in adherence to PRISMA guidelines. The inclusion criteria for study selection were: English or Mandarin comparative studies that evaluated clinical (Patient Reported Outcome Measures, incidence of reoperations and postoperative complications) or radiographic (time to union and incidence of secondary loss of reduction) outcomes of metal and non-metal fixation methods for patellar fractures. From an initial pool of 1269 studies, 19 studies involving 1612 patients were included in the meta-analysis after full-text evaluation and accounting for exclusion criteria.
Clinically, the reduction in reoperations (OR = 0.22, 95% CI [0.10, 0.51], P = 0.0003), direct (OR = 0.17, 95% CI [0.08, 0.33], P < 0.00001) and indirect (OR = 0.50, 95% CI [0.27, 0.93], P = 0.03) implant-related postoperative complications were significantly in favor of non-metal fixation. Radiographically, the decrease in time to union (SMD = -0.79, 95% CI [-1.11, -0.47], P < 0.00001) in the non-metal group compared to the metal group was also significant. The remaining results were comparable.
This meta-analysis suggests that non-metallic internal fixation had similar if not superior outcomes to their metallic counterparts, with fewer implant-related complications and improved postoperative recovery. Given the higher re-operation rates associated with metallic fixation, non-metallic methods may be preferable from economic and safety perspectives. Nevertheless, more homogenous studies with standardised fracture configurations and treatment modalities are needed before declaring non-metallic fixation as the gold standard for patellar fractures.
本文旨在系统回顾和荟萃分析与对照金属固定组相比，非金属固定方法治疗髌骨骨折的临床和影像学结果的现有证据，以期深入了解其有效性。
两名研究人员按照PRISMA指南，系统回顾了9个英文或中文电子数据库（Cochrane图书馆、EMBASE、谷歌学术、Medline、PubMed、Scopus、科学网、中国知网和万方数据）中的研究。研究选择的纳入标准为：评估金属和非金属固定方法治疗髌骨骨折的临床（患者报告结局量表、再次手术发生率和术后并发症）或影像学（骨折愈合时间和二次复位丢失发生率）结果的英文或中文比较研究。在对1269项研究进行初步筛选后，经过全文评估并考虑排除标准，19项涉及1612例患者的研究被纳入荟萃分析。
在临床方面，再次手术的减少（OR = 0.22，95% CI [0.10, 0.51]，P = 0.0003）、直接（OR = 0.17，95% CI [0.08, 0.33]，P < 0.00001）和间接（OR = 0.50，95% CI [0.27, 0.93]，P = 0.03）植入物相关的术后并发症显著有利于非金属固定。在影像学方面，与金属组相比，非金属组骨折愈合时间的缩短（SMD = -0.79，95% CI [-1.11, -0.47]，P < 0.00001）也很显著。其余结果相当。
这项荟萃分析表明，非金属内固定的结果即便不比金属内固定更好，至少也与之相似，植入物相关并发症更少，术后恢复更佳。鉴于金属固定的再次手术率较高，从经济和安全角度来看，非金属方法可能更可取。然而，在将非金属固定宣布为髌骨骨折的金标准之前，还需要更多具有标准化骨折构型和治疗方式的同类研究。
