摘要
目的系统评价我国小切口复位内固定术(MIPPO)与切开复位内固定治疗胫骨远端骨折的疗效与安全性。方法计算机检索中国知网(CNKI:2003年9月-2013年5月)、万方数据库(2003年9月-2013年5月)、维普数据库(2003年9月-2013年5月),中国生物医学数据库及超星电子图书。手工检索国内近五年来发表于《中华骨科杂志》、《中国矫形外科杂志》及《临床骨科杂志》等各骨科杂志及相关杂志的相关文献。收集所有相关MIPPO与切开复位内固定治疗胫骨远端骨折的随机对照试验及半随机对照试验,采用Cochrane协作网提供的软件RevMan5.0进行系统评价。结果共纳入12篇随机对照试验及半随机对照试验,共733例患者,纳入研究质量评价结果为B级10篇,C级2篇。系统评价结果显示,与切开复位内固定组相比,MIPPO组术中失血量少[SMD=-4.46,95%CI(-5.87,-3.05),P<0.05];骨折愈合时间短[SMD=-1.54,95%CI(-2.02,-1.06),P<0.05];术后优良率高[RR=1.22,95%CI(1.13,1.32),P<0.05],但两组手术时间比较差异无统计学意义。结论采用MIPPO术治疗胫骨远端骨折具有明显的优势,值得临床推广。但由于该系统评价尚存在一定的局限性,故需要大量严格的、大样本量的、多中心性的,并且采用正确的随机、盲法、分配隐藏以及对失访与退出的患者进行正确的意向性分析(ITT分析)等文献研究来进一步论证。
Objective Systematicly reviewing of MIPPO with open reduction and internal fixation of distal tibial fracture efficacy and safety.Methods We searched for all randomized controlled and quasi-randomized controlled trials of MIPPO and open reduction and internal fixation for the treatment of distal tibial fractures of patients by electronically searching CNKI （2003.9-2013.5）,WANFANG （2003.9-201 3.5）, VIP（2003.9-2013.5）,CBM,CHAOXING.We handsearched domestic literature published in orthopedic journals and related magazines in the past five years：China Journal of Orthopaedics Series,Orthopaedic Journal of China,Journal of Clinical Orthopaedics,etc.The Revman5.0 provided by the Cochrane Collaboration was used for management and analysis.Results 1 2 randomized controlled and quasi-Randomized controlled were included.733 patients,Evaluation results for the quality of included studiesshow 12 B grade,2 C grade.System evaluation results show that less blood loss in the MIPPO group compared with the open reduction and internal fixation group[SMD=-4.46,95%CI （-5.87,-3.05）,P 〈0.05];fracture healing time is short [SMD=-1.54,95%CI （-2.02,-1.06）,P 〈0.05];postoperative excellent rate [RR = 1.22,95%CI（1.13,1.32）,P 〈 0.05 ], but no significant difference in operative time. Conclusion Using MIPPO treatment of distal tibial fractures has obvious advantages,worthy of promotion.However,due to the systematic review are still some limitations,it requires a lot of rigorous,large sample volume,multi-center,and with the right randomized,blinded,allocation concealment and right and exit of patients lost to follow correct ITT analysis,literature studies further demonstrated.
出处
《新疆医科大学学报》
CAS
2014年第9期1186-1189,共4页
Journal of Xinjiang Medical University
基金
新疆维吾尔自治区高技术研究发展项目(201332108)
关键词
切开复位内固定术
胫骨远端骨折
META分析
MIPPO
MIPPO
open reduction and internal fixation
distal tibial fractures
meta analysis
