MIPPO与切开内固定治疗胫骨中下段的系统评价

目的：系统评价MIPPO与切开内固定治疗胫骨中下段骨折的疗效与安全性。方法：计算机检索中国知网（CNKI：2003～2013．6）、万方数据库（2003～2013．6）、维普数据库（2003～2013．6），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国矫形外科杂志、临床骨科杂志等杂志的原始文献。收集所有相关MIPPO与切开内固定治疗胫骨中下段骨折的随机对照试验及半随机对照试验，采用1KevMan5．0软件进行系统评价。结果：共纳入2篇随机对照试验及半随机对照试验，共例152患者，纳入研究质量评价。结果：2篇全为B级。系统评价结果显示，与切开内固定组相比，MIPPO组术中出血量少[MD=-38．55，95％CI（-41．41，-35．70），P〈0．05］；骨折愈合时间短[SMD=-1．94，95％O（-3．36，-0．53），P=0．007〈0．05］；术后优良率高［RR=1．45，95％CI（1．17，1．80），P=0．0006〈0．05］，但在手术时间方面差异无统计学意义。结论：采用MIPPO术是治疗胫骨中下段骨折优良方法，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、分配隐藏的文献研究来进一步论证。

Systematic Review on MIPPO and Open Reduction and Internal Fixation for the Treatment of Distal Tibial Fractures

Objective： Systematic reviews MIPPO with open reduction- n and internal fixation of tibial fracture efficacy and safety. Methods We searched Chinese Text （CNKI：2003～2013.6）,Wan FangDATA （2003～2013.6）,VIP database （2003～2013.6）,Chinese Biomedical Databa-se and Superstar electronic books. Hand searched nearly five years published in Chinese Journal of Orthopaedic Surgery, Clinical Orthopaedics and other magazines of the original literature. Collect all relevant MIPPO with open reduction and internal fixation of tibial fractures randomized con trolled trials and quasirandomized controlled trials, systematic reviews using RevMan5.0 software. Results Were in cluded in two randomized controlled trials and quasirandomized controlled trials of patients with 152 patients includ ed in the study quality evaluation results： two full Class B. System evaluation results show that, compared with open reduction and internal fixation group, MIPPO group less blood loss [MD= -38.55,95% CI（-41.41,-35.70）,P〈0.05]; fracture healing time is short [SMD=-1.94,95%CI（-3.36,-0.53）,P=0.007〈0.05];postoperative excell- ent rate[RR=l. 45,95%CI （1.17,1.80）,P=O.OOO6〈O.OS],but in the surge- ry time the difference was not statistically significant. Con clusion MIPPO technique is used in the treatment of tibial fractures fine under way, worthy of promotion. However, due to the systematic review are still some limitations, it requires a lot of rigorous, large sample volume, multicenter, and with the right randomized, blinded, allocation concealment literature studies further demonstrated.