Department of Traumatic Orthopedics, Yuncheng Central Hospital affiliated to Shanxi Medical University, Yuncheng, Shanxi Province, 044000, China.
Department of Clinical Laboratory, Yuncheng Central Hospital affiliated to Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng, Shanxi Province, 044000, China.
J Orthop Surg Res. 2024 Jul 12;19(1):403. doi: 10.1186/s13018-024-04900-y.
Intramedullary nail (IMN) and plate fixation are the most commonly used surgical modalities for distal tibia fractures. However, the superiority of their efficacy regarding functional outcomes and complications remains controversial. Here, we performed a systematic review and meta-analysis to compare the efficacy of these two modalities.
Randomized controlled trials (RCTs) comparing the efficacy of IMN and plate fixation in distal tibia fractures were searched in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and Cochrane Library up to January 31, 2024. Weighted mean difference (WMD) and odds ratio (OR) with corresponding 95% confidence interval (CI) were estimated using a random-effect model for continuous and categorical outcomes, respectively.
A total of 20 RCTs comprising 1528 patients were included. Compared with plate fixation, IMN significantly shortened surgery time (WMD=-10.73 min, 95%CI: -15.93 to -5.52), union time (WMD=-1.56 weeks, 95%CI: -2.82 to -0.30), and partial (WMD=-1.71 weeks, 95%CI: -1.91 to -0.43) and full (WMD=-2.61 weeks, 95%CI: -3.53 to -1.70) weight-bearing time. IMN was associated with markedly reduced risk of wound infection (OR = 0.44, 95%CI: 0.31-0.63) and secondary procedures (OR = 0.72, 95%CI: 0.55-0.95), but increased the risk of malunion (OR = 1.53, 95%CI: 1.02-2.30) and anterior knee pain (OR = 3.94, 95%CI: 1.68-9.28). The rates of nonunion, delayed union, and functional assessment scores did not significantly differ between the two groups. The percentages of patients obtaining an excellent functional outcome or an excellent and good functional outcome post-operation were comparable.
Both IMN and plate fixation are effective modalities for the surgical treatment of distal tibia fractures. IMN seems to be preferred since it confers more advantages, but the elevated rates of malunion and knee pain require attention. The decision on fixation modality should be tailored to the specific fracture, considering these pros and cons.
髓内钉（IMN）和钢板固定是治疗胫骨远端骨折最常用的手术方法。然而，关于其在功能结果和并发症方面的疗效优势仍存在争议。在这里，我们进行了一项系统评价和荟萃分析，以比较这两种方法的疗效。
我们在 PubMed、Web of Science、EMBASE、ClinicalTrials.gov 和 Cochrane Library 中检索了比较胫骨远端骨折髓内钉和钢板固定疗效的随机对照试验（RCT），检索时间截至 2024 年 1 月 31 日。使用随机效应模型分别估计连续和分类结果的加权均数差值（WMD）和优势比（OR）及其相应的 95%置信区间（CI）。
共纳入 20 项 RCT，包含 1528 名患者。与钢板固定相比，IMN 显著缩短手术时间（WMD=-10.73 分钟，95%CI：-15.93 至-5.52）、愈合时间（WMD=-1.56 周，95%CI：-2.82 至-0.30）、部分负重时间（WMD=-1.71 周，95%CI：-1.91 至-0.43）和完全负重时间（WMD=-2.61 周，95%CI：-3.53 至-1.70）。IMN 与降低伤口感染风险（OR=0.44，95%CI：0.31-0.63）和二次手术风险（OR=0.72，95%CI：0.55-0.95）显著相关，但增加了畸形愈合风险（OR=1.53，95%CI：1.02-2.30）和前膝疼痛风险（OR=3.94，95%CI：1.68-9.28）。两组患者的非愈合率、延迟愈合率和功能评估评分无显著差异。术后获得优秀功能结果或优秀和良好功能结果的患者百分比相当。
IMN 和钢板固定都是治疗胫骨远端骨折的有效方法。由于 IMN 具有更多优势，因此似乎更受欢迎，但畸形愈合和膝痛发生率较高需要引起关注。固定方式的选择应根据具体骨折情况，权衡这些利弊。
