国内关节镜下内固定和切开复位内固定治疗轻型胫骨平台骨折的疗效及术后并发症的Meta分析*

A meta-analysis of efficacy and postoperative complications of arthroscopic reduction and open reduction of internal fixation in treatment of light tibial plateau fracture in China*

摘要:

以Meta分析的方法评价关节镜下内固定和切开复位内固定对治疗轻型胫骨平台骨折的疗效比较。方法?计算机检索国内外有关关节镜下内固定治疗轻型胫骨平台骨折的相关研究，通过进行文献质量评价，应用Rev?Man?5.3分析软件进行Meta分析。结果?共纳入随机对照研究（RCT）文献14篇，共计1?364例患者。其中，关节镜下内固定组680例，切开复位内固定组684例。Meta分析结果显示，关节镜下内固定与切开复位内固定相比，能明显减少术后短期和长期术后并发症的发生（P?=0.000）；且能缩短手术时间，减少切口长度，减少术中出血量（P?=0.000），缩短住院时间、完全负重下地时间、骨折愈合时间（P?=0.000）；在中短期功能评分优良率方面，关节镜更有优势（P?=0.004），差异均有统计学意义。结论?该系统评价为关节镜下内固定治疗轻型胫骨平台骨折的疗效及并发症方面提供循证医学的证据支持，对手术时间、切口长度、术中出血量、住院时间、下地负重时间、骨折愈合时间、术后6个月、12功能评分优良率和术口感染等并发症的有效性及安全性进行系统评价，与传统切开复位内固定术进行比较，关节镜下内固定治疗轻型胫骨平台骨折是安全可靠的。

Abstract:

To compare the clinical efficacy and postoperative complications of arthroscopic reduction versus open reduction in internal fixation of light tibial plateau fracture by meta-analysis.?Methods?We searched EMBASE, Pubmed, Cochrane Library, CNKI, WanFang Database on computer. Articles of RCT about arthroscopic reduction and open reduction in internal fixation of light tibial plateau fracture were collected and enrolled in the study. Quality of the studies was assessed in terms of study design, definitions of main variables, statistics and bias control. The statistical analysis was conducted by using the Cochrane Collaboration review Manager 5.3.?Results?14 articles including 1 364 patients, of which 680 cases were treated in arthroscopic reduction and internal fixation while 684 cases treated in open reduction and internal fixation, were carefully enrolled in the study. The results showed that arthroscopic reduction had advantages over open reduction in the aspects of reducing of postoperative complications in the short and long term after operation (P?=?0.000), shortening operation time, reducing length of incision, reducing surgical blood loss volume (P?=?0.000), shortening average length of hospital stay, weight bearing time and fracture healing time (P?=?0.000), meanwhile, arthroscopic reduction can improve the excellent rate of knee joint clinical function (P?=?0.004).?Conclusion?This systematic review provides the evidence that the ARIF offers a safe and efficient alternative to treat the light tibial plateau fracture.