腓骨固定在胫腓骨关节外骨折中治疗效果的Meta分析

目的:通过Meta分析比较腓骨固定在胫腓骨关节外骨折中的作用及重要性。方法:通过对中国知网、维普、万方、The Cochrane Library、Web of science、Pubmed等数据库关于固定腓骨与否对胫腓骨关节外骨折治疗疗效比较的相关文献进行检索,检索时间为2012年1月至2022年2月,使用RevMan 5.3软件进行统计分析。对腓骨固定组与不固定组的复位不良率、旋转畸形率、内翻或外翻畸形率、前或后发畸形率、不愈合率、术后感染率、二次手术率及手术时间进行比较。结果:共纳入11篇文献,6篇随机对照研究和5篇病例对照研究,有8篇为高质量文献,共813例患者,其中腓骨固定治疗383例,未固定腓骨430例。Meta分析结果显示,与未固定腓骨相比,治疗胫腓骨关节外骨折时固定腓骨可以降低术后旋转畸形率RR=0.22,95%CI(0.10,0.45),P<0.000 1]和内翻或外翻畸形率RR=0.34,95%CI(0.14,0.84),P=0.02],并促进骨折愈合RR=0.76,95%CI(0.58,0.99),P=0.04]。而复位不良率RR=0.48,95%CI(0.10,2.33),P=0.36],前或后畸形率RR=1.50,95%CI(0.76,2.96),P=0.24],术后感染率RR=1.43,95%CI(0.76,2.72),P=0.27],二次手术率RR=1.32,95%CI(0.82,2.11),P=0.25],手术时间MD=10.21,95%CI(-17.79,38.21),P=0.47]比较差异均无统计学意义(P>0.05)。结论:在治疗胫腓骨关节外骨折时腓骨固定组相较于不固定组在防止旋转畸形和内翻或外翻畸形以及促进愈合方面更具优势。

Meta-analysis of the role of fibular fixation in tibiofibular fractures

Objective To compare the role and importance of fibular fixation in tibiofibular fractures by Meta-analysis. Methods The literature related to the comparison of the efficacy of fixation of the fibula with or without fixation on the treatment of tibiofibular fractures was searched through the databases of China Knowledge Network,Wipu,Wanfang,The Cochrane Library,Web of science and Pubmed,and statistical analysis was performed using RevMan 5.3 software. The rates of malrotation,rotational deformity,internal/external deformity,anterior/posterior deformity,non-union,infection,secondary surgery and operative time were compared between the fibula fixation and non-fixation groups. Results A total of 11 publications were included,six randomised controlled trials and five case-control trials,eight of which were of high quality. A total of 813 cases were included,of which 383 were treated with fibula fixation and 430 with unfixed fibulae.Meta-analysis results showed that fixation of the fibulae in the treatment of tibiofibular fractures reduced the rates of postoperative rotational deformityRR=0.22,95%CI(0.10,0.45),P<0.000 1] and internal/external deformityRR=0.34,95%CI(0.14,0.84),P=0.02] and promoted fracture healingRR=0.76,95%CI(0.58,0.99),P=0.04]. In contrast,the rates of poor reductionRR=0.48,95% CI(0.10,2.33),P=0.36],anterior/posterior deformityRR=1.50,95%CI(0.76,2.96),P=0.24],infectionRR=1.43,95%CI(0.76,2.72),P=0.27],secondary surgeryRR=1.32,95%CI(0.82,2.11),P=0.25],and operative timeMD=10.21,95%CI(-17.79,38.21),P=0.47] were not statistically significant (P>0.05) for comparison. Conclusion Simultaneous fixation of the tibia and fibula is clinically more effective in the treatment of tibiofibular fractures.