目的:腓骨髓内钉内固定(FINF)与钢板内固定(PF)治疗成人踝关节骨折的有效性和安全性尚不清楚。因此,我们进行了一项荟萃分析,以评估FINF与PF的疗效和安全性,旨在为矫形外科医生提供有价值的见解,在选择两种内固定方法进行患者治疗时。
方法:PubMed,EMBASE,和SCOPUS系统搜索了FINF和PF在成人踝关节骨折中比较的文章。功能成果,并发症,和骨结合进行了比较。
结果:本研究共纳入7项研究,涉及586名患者。结果显示两组在术后3、6和12个月的功能结果没有统计学上的显著差异。有利于FINF的结果包括较低的感染率(RR=0.23,95CI,0.11至0.47,P<0.0001)。相反,PF组在硬件故障率方面表现优异(RR=2.05,95CI,1.16~3.60,P=0.01).在欧洲进行的研究亚组中,硬件故障率的结果具有统计学意义(RR=2.74,95CI,1.45至5.18,P=0.002)。在老年人亚组中也发现了类似的发现(RR=4.25,95CI,1.57至11.50,P=0.004)。
结论:本系统综述表明,FINF在治疗成人踝关节骨折方面具有相当的有效性,与PF相比。因此,必须进一步精确地描述FINF和PF的手术适应症,以降低并发症的风险.然而,更大的样本量和多中心的RCT是必要的,以证实这一结论在未来。
OBJECTIVE: The effectiveness and safety of fibular intramedullary nail fixation (FINF) compared to plate fixation (PF) in treating ankle fractures among adults remains unclear. Therefore, we conducted a meta-analysis to assess the efficacy and safety of FINF versus PF, aiming to provide orthopedic surgeons with valuable insights when choosing between the two internal fixation methods for patient treatment.
METHODS: PubMed, EMBASE, and SCOPUS were systematically searched for articles comparing FINF and PF in ankle fractures among adults. Functional outcomes, complications, and bony union were compared between the implants.
RESULTS: A total of seven studies were included in the study, involving 586 patients. The results revealed no statistically significant differences in functional outcomes between two groups at 3, 6, and 12 months postoperatively. The outcomes favoring FINF comprised a lower infection rate (RR = 0.23, 95%CI, 0.11 to 0.47, P < 0.0001). Conversely, the PF group exhibited a superior performance in terms of hardware failure rate (RR = 2.05, 95%CI, 1.16 to 3.60, P = 0.01). A statistically significant difference was observed in the results of hardware failure rate in the subgroup of studies conducted in Europe (RR = 2.74, 95%CI, 1.45 to 5.18, P = 0.002). Comparable findings were also noted in a subgroup of older adults (RR = 4.25, 95%CI, 1.57 to 11.50, P = 0.004).
CONCLUSIONS: This systematic review suggests that FINF exhibits comparable effectiveness in the management of ankle fractures among adults, as compared to PF. Consequently, it is imperative to further delineate the surgical indications for both FINF and PF with precision to mitigate the risk of complications. Nevertheless, larger sample sizes and multi-center RCTs are imperative to corroborate this conclusion in the future.