Comparison Of The Treatment In Tibial Fracture Minimally Invasive Percutaneous Plate Osteosynthesis With Interlocking Intramedullary Nail: A Meta-analysis

ObjectiveThe aim of this article was to evaluate the efficacy and safety of minimally invasive percutaneous plate and interlocking intramedullary nail in the treatment of tibial fractures,and to provide a statistical basis for clinical diagnosis and treatment.MethodsStandard electronic database were searched to retrieve PubMed(1997.1-2017.1)?Embase(1997.1-2017.1)?Cochrane Library(1997.1-2017.1)?CNKI(1997.1-2017.1)? Wanfang Database(1997.1-2017.1).Two researchers independently carry on literatures screening according to the inclusion criteria and exclusion criteria,access the Chinese and English literatures that meet the conditions for minimally invasive percutaneous plate and interlocking intramedullary nail technology in the treatment of tibial fractures.The quality of the included literatures were evaluated,and the relevant data were extracted after reading the full text.The statistical analysis and evaluation of the extracted data were carried out by RevMan 5.3 downloaded from the Cochrane Library.The outcome indicators in this article include Johner-Wruhs scale?incidence of aseptic loosening or fracture of internal fixation?incidence of nonunion?incidence of pain in the knee?the operation time?intraoperative fluoroscopy volume? intraoperative blood loss? incidence of the soft tissue complications(including the poor wound healing,infection,blood vessels and nerves injury)?fracture healing time?hospitalization time?hospitalization costs.ResultsThe meta-analysis of 13 studies including 839 patients showed that: compared minimally invasive percutaneous plate and interlocking intramedullary nails in the treatment of tibial fractures,the results are as follows:1.Johner-Wruhs scale(OR=1.12,95%CI(0.65,1.93),P=0.68),there was no significant difference;2.soft tissue complications(OR=1.36,95%CI(0.64,2.88),P=0.42),there was no significant difference;3.incidence of aseptic loosening or fracture of internal fixation(OR=0.75,95%CI(0.27,2.00),P=0.54),there was no significant difference;4.incidence of nonunion(OR=0.69,95%CI(0.13,3.56),P=0.66),there was no significant difference;5.incidence of pain in the knee(OR=0.31,95%CI(0.14,0.70),P=0.005),there was significant difference;6.heterogeneity of operation time is great,the sensitivity analysis suggests that statistical results are unstable;7.intraoperative blood loss(MD=-15.29,95%CI(-40.50,9.93),P=0.23),there was no significant difference;8.heterogeneity of intraoperative fluoroscopy volume is great,the sensitivity analysis suggests that statistical results are unstable;9.heterogeneity of fracture healing time is great,the sensitivity analysis suggests that statistical results are unstable;10.heterogeneity of hospitalization time is great,the sensitivity analysis suggests that statistical results are unstable;11.hospitalization costs(MD=-0.61,95%CI(-0.75,-0.47),P<0.00001),there was significant difference.ConclusionCompared with interlocking intramedullary nail in the treatment of tibial fractures,minimally invasive percutaneous plate technology has following characteristics:1.Lower incidence of pain in the knee,lesser hospitalization cost.2.The Johner-Wruhs scale?the incidence of soft tissue complications?incidence of aseptic loosening or fracture of internal fixation?incidence of nonunion and the intraoperative blood loss were similar.3.The difference of operative time ?intraoperative fluoroscopy?fracture healing time and hospitalization time have no sufficient evidence to support.