Efficacy of suprapatellar versus infrapatellar approach in tibial intramedullary nail fixation for tibial fracture:a systematic review and meta-analysis
10.3760/cma.j.issn.1001-8050.2019.08.012
- VernacularTitle:髌上入路与髌下入路髓内固定治疗胫骨骨折疗效的Meta分析
- Author:
Yuanzheng WANG
1
;
Long CHEN
;
Rongfeng SHE
;
Tao DAI
;
Yi ZHANG
;
Jinhai LAN
;
Shifu WU
Author Information
1. 贵州省人民医院骨科
- Keywords:
Tibial fractures;
Fracture fixation;
intramedullary;
Suprapatellar approach
- From:
Chinese Journal of Trauma
2019;35(8):742-749
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy of suprapatellar versus infrapatellar approach in tibial intramedullary nail fixation for tibial fracture. Methods Clinical trials that evaluated suprapatellar approach and infrapatellar approach for tibia intramedullary nailing fixation were searched in PubMed, EMBASE, Cochrane Central Register of Controlled Trials ( CENTRAL ) , Chinese Biology Medicine ( CBM) , Wanfang, Weipu and CNKI databases. Methodological qualities of the included studies were assessed using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Sensitivity analyses were performed to determine whether overall results were reliable. Publication bias was detected using Begg's test and Egger's test. Lysholm score, reoperation rate, Hospital for Special Surgery ( HSS ) score, operation time, intraoperative blood loss and hospital stay were selected to evaluate the clinical effect of suprapatellar approach and infrapatellar approach in tibial intramedullary nail fixation for tibial fracture. Results Two randomized controlled trials and six case-controlled studies involving 787 patients were included in the analysis. Sensitivity analyses indicated that the results were statistically significant. No significant publication bias was detected by Begg's test or Egger's test. Our meta-analysis indicated that suprapatellar approach had significantly higher Lysholm score ( MD=1. 04, 95％CI 0. 82 -1. 26, P<0. 05, I2 =10. 5％) and HSS score ( MD =0. 97, 95％CI 0. 65 -1. 30, P <0. 05, I2 =0 ) than infrapatellar approach ( P <0. 05 ) . Additionally, there were no statistical differences between the two procedures in reoperation rate, operation time, intraoperative blood loss and hospital stay (P>0. 05). Conclusion Compared with infrapatellar approach, suprapatellar approach in intramedullary nail fixation for tibial fracture can better relieve the pain, keep stability and motion of the knee joint and promote function recovery of knee joint.
