Zhou Hecheng, Zhang Yanci, Wei Liting, Ge Xiangliang, Liu Dehang, Dong Yue, Chen Yang, Liu Zongshuan, Sun Zhenhui
Department of Orthopaedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Clinical Medicine, Clinical College of Hebei Medical University, Shijiazhuang, Hebei, China.
Int J Surg. 2025 Aug 1;111(8):5582-5592. doi: 10.1097/JS9.0000000000002620. Epub 2025 Jun 4.
This meta-analysis aims to compare the minimally invasive percutaneous plate osteosynthesis (MIPPO) versus intramedullary nail (IMN) for distal tibial fractures. The comparison focuses on postoperative functional outcomes, complication rates, time to fracture union, and other relevant clinical indicators.
A comprehensive computerized search was conducted across PubMed, Web of Science, Cochrane Library, and Embase, covering all available publications up to 4 August 2024. Two independent researchers assessed the quality of the selected studies using predefined inclusion and exclusion criteria. Key demographic and clinical data, such as patient gender, age, surgery duration, postoperative functional outcomes, and complication rates, were collected from the included studies. Statistical analysis was performed using Review Manager 5.3.
A total of 23 studies, involving 1742 patients, were included in the meta-analysis, with 858 patients treated using MIPPO and 884 patients treated with IMN. The pooled data revealed that patients who underwent IMN experienced a shorter time to bone union, along with a lower incidence of infection, ankle stiffness, and soft tissue complications. Conversely, MIPPO demonstrated advantages in reducing the rates of malalignment and anterior knee pain. No significant differences were observed between the two methods in terms of functional scores, delayed or non-union rates, and overall complication rates.
IMN was found to promote faster bone union compared to MIPPO with high heterogeneity but no difference was found in function score between the two groups. Although both techniques exhibited similar overall complication rates, the specific types of complications varied between the two. The MIPPO group showed lower rate of malalignment rate and knee pain, whereas the IMN group had fewer infections, ankle stiffness, and soft tissue issues. No significant difference was noted in the rates of delayed or non-union. The choice of surgical method may depend on individual patient conditions, with different techniques potentially better suited for reducing the risk of certain complications. Further clinical studies are needed to better understand patient preferences and optimize treatment strategies for distal tibial fractures.
本荟萃分析旨在比较微创经皮钢板接骨术（MIPPO）与髓内钉（IMN）治疗胫骨干骺端骨折的效果。比较重点在于术后功能结果、并发症发生率、骨折愈合时间及其他相关临床指标。
通过全面检索PubMed、科学网、考克兰图书馆和Embase数据库，纳入截至2024年8月4日的所有相关出版物。两名独立研究人员根据预先设定的纳入和排除标准评估所选研究的质量。从纳入研究中收集关键人口统计学和临床数据，如患者性别、年龄、手术时长、术后功能结果及并发症发生率。使用RevMan 5.3进行统计分析。
本荟萃分析共纳入23项研究，涉及1742例患者，其中858例采用MIPPO治疗，884例采用IMN治疗。汇总数据显示，接受IMN治疗的患者骨折愈合时间较短，感染、踝关节僵硬和软组织并发症的发生率较低。相反，MIPPO在降低畸形和前膝疼痛发生率方面具有优势。两种方法在功能评分、延迟愈合或不愈合率以及总体并发症发生率方面无显著差异。
与MIPPO相比，IMN能促进更快的骨折愈合，异质性较高，但两组功能评分无差异。尽管两种技术的总体并发症发生率相似，但并发症的具体类型有所不同。MIPPO组的畸形率和膝痛发生率较低，而IMN组的感染、踝关节僵硬和软组织问题较少。延迟愈合或不愈合率无显著差异。手术方法的选择可能取决于患者个体情况，不同技术可能更适合降低某些并发症的风险。需要进一步的临床研究以更好地了解患者偏好并优化胫骨干骺端骨折的治疗策略。
