Meta-analysis of suprapatellar and infrapatellar intramedullary nails in the treatment of adult tibial shaft fractures
Objective To analyze the efficacy of infrapatellar(IP)and suprapatellar(SP)techniques in the treatment of adult tibial fractures.Methods In this systematic review and meta-analysis that meets the PRISMA standard,a total of 7 databases were searched from January 2012 to November 2022,including China National Knowledge Infrastructure,VIP Technology Journal Database,Wanfang Database,China Biomedical Literature Database,Pubmed,Embase,and Cochrane Library Database.Randomized controlled trials(RCTs)involving the comparison of IP and SP intramedullary nails for the treatment of tibial fractures were searched.Use a pre-designed retrieval strategy for retrieval and evaluate the methodological quality of all qualified literature through the Cochrane collaborative tool.Extract intraoperative fluoroscopy frequency,intraoperative bleeding volume,surgical time,hospital stay,fracture healing time,HSS score,Lysholm score,visual analog scale(VAS)of pain,range of motion(ROM)of knee joint,incision infection rate,and reoperation rate.The data were analyzed using Rview Manager 5.3 software.Results A total of 12 studies were analyzed(874 patients),including 440 in the SP group and 434 in the IP group.The stability and reliability of the results were mainly evaluated through sensitivity analysis,while the publication bias of meta-analysis was evaluated through publication bias detection.The results showed that the frequency of intraoperative fluoroscopy in SP group was lower than that in IP group(MD =-13.61,95%CI-15.13-12.09,P<0.000 01);The operation time in SP group was significantly shorter than that in IP group(MD =-2.30,95%CI-3.44--1.16,P<0.0001);Compared with the infrapatellar approach,the patients with suprapatellar approach could obtain higher Lysholm score(MD = 7.66,95%CI 6.25-9.07,P<0.000 01);The HSS score of SP group was significantly higher than that of IP group(MD = 6.47,95%CI 4.69-8.25,P<0.000 01);The VAS score of SP group was significantly lower than that of IP group(MD =-0.67,95%CI-0.98--0.35,P<0.0001);The ROM of SP group was significantly higher than that of IP group(MD = 2.50,95%CI 0.70-4.30,P = 0.006);There was no significant difference in reoperation rate,incision infection rate,fracture healing time,intraoperative bleeding,and hospital stay between the two groups(P>0.05).Conclusions The SP intramedullary nail approach will significantly reduce intraoperative fluoroscopy frequency and surgical time for the treatment of adult tibial fractures,which is closely related to a decrease in postoperative pain scores and improved functional prognosis of the knee joint.
Tibial fracturesFracture fixation,intramedullaryBone nails
NETL
NSTL
万方数据
维普
