背景:钢板或螺钉内固定治疗后踝骨折仍存在争议。钢板固定被认为具有更好的稳定性,但软组织损伤更多;螺钉固定侵入性较小,并且可以减少失血和手术时间。我们进行了这项荟萃分析,以探讨钢板和螺钉固定在后踝骨折患者中的术中和术后疗效。
方法:PubMed,科克伦,Embase,根据系统评价和荟萃分析(PRISMA)指南的首选报告项目搜索Scopus和中国国家知识基础设施数据库。使用随机效应模型和95%置信区间。感兴趣的结果是手术时间,失血,住院时间,美国骨科足踝评分(AOFAS),骨愈合时间,完整的重量承受时间,下床活动时间,视觉模拟量表(VAS),并发症发生率,以及联合螺钉等的使用率。结果:一项随机临床试验和52项回顾性队列研究共3757例患者(螺钉组1956例,钢板组1801例)纳入系统评价。与螺钉组相比,板组手术时间明显延长,更多的术中失血,但住院时间较短,更好的AOFAS,贝尔德·杰克逊得分更好,更好的AOFAS和BairdJackson优好率,骨愈合时间短,更短的时间,使完全承重,更短的时间使下床活动,术后疼痛较轻,并发症发生率较低,较小的松动率,较低的畸形率,术后骨关节炎较少。
结论:钢板内固定是后踝骨折患者螺钉内固定的有利选择。虽然钢板内固定术存在手术时间较长、失血较多的风险,它提供了更好的术后功能结果,较短的愈合,与螺钉固定相比,负重和离床活动时间和疼痛较小。
BACKGROUND: Treatment of posterior malleolar fracture with plate or
screw fixation is still controversial. Plate fixation is considered to have better stability but more soft tissue damage;
screw fixation is less invasive and may yields lesser blood loss and surgery time. We conducted this meta-analysis to explore intraoperative and postoperative efficacy between plate and
screw fixation in posterior malleolar fractured patients.
METHODS: PubMed, Cochrane, Embase, Scopus and Chinese National Knowledge Infrastructure databases were searched in accordance with the Preferred Reporting Items for Systematic
Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals was used. The outcomes of interest were surgery time, blood loss, length of hospital stay, American Orthopedic Foot and Ankle Score (AOFAS), bone healing time, full weight bearing time, off bed ambulation time, Visual Analogue Scale (VAS), complication rate, and rate of use of syndesmosis screw etc. RESULTS: One randomized clinical trial and fifty-two retrospective cohort studies with a total of 3757 patients (1956 in screw group and 1801 in plate group) were included in the systematic
review. Compared to screw group, plate group yielded significantly longer surgery time, more intraoperative blood loss, but shorter length of hospital stay, better AOFAS, better Baird Jackson score, better AOFAS and Baird Jackson excellent-good rate, shorter bone healing time, shorter time enabling full weight bearing, shorter time enabling off bed ambulation, lesser postoperative pain, lesser complication rate, lesser loosening rate, lesser malunion rate, and lesser postoperative osteoarthritis.
CONCLUSIONS: Plate fixation is a favorable alternative to screw fixation in posterior malleolar fractured patients. Although plate fixation was at risk of longer surgery time and more blood loss, it provided better postoperative functional outcome, shorter healing, weight bearing and off bed ambulation time and lesser pain compared to screw fixation.