摘要目的 评价应用锁定加压钢板(LCP)与逆行髓内钉(RIMN)治疗全膝关节置换术(TKA)后股骨髁上假体周围骨折的疗效,为手术医师在固定方式的选择上提供依据. 方法 检索Cochrane Library、PubMed、Embase、Medline和中国生物医学文献、万方、维普中文科技期刊数据库及中国知网等数据库有关在TKA术后股骨髁上假体周围骨折应用LCP和RIMN的临床对照研究,根据纽卡斯尔渥太华评分(NOS)量表对纳入的文献进行评分,使用RevMan 5.3软件进行Meta分析,比较两种治疗方式在手术时间、美国膝关节协会评分(KSS)、骨折愈合时间、不愈合率、再手术率及并发症发生率方面的差异. 结果 共纳入10篇文献,487例患者,其中LCP组296例,RIMN组191例.Meta分析结果显示,两组的手术时间(MD=10.89,95％CI-9.56 ～31.33)、术后KSS膝关节功能评分(MD=1.11,95％CI-8.88 ～ 11.10)和骨折愈合时间(MD=0.00,95％ CI-1.51 ～1.51)差异均无统计学意义(P＞0.05).同时,两组骨折部位不愈合率(OR =0.71,95％CI0.38～1.31)、再手术率(OR=0.65,95％CI0.22 ～ 1.91)及并发症发生率(OR=0.69,95％CI0.38～1.26)差异也无统计学意义(P＞0.05). 结论 LCP组与RIMN组在手术时间、术后膝关节功能KSS、骨折愈合时间、骨折部位不愈合率、再手术率及并发症发生率等方面无明显差异.LCP与RIMN治疗TKA术后股骨髁上假体周围骨折的临床疗效相似.

abstractsObjective To evaluate the efficacy of locking compression plate (LCP) and retrograde intramedullary nail (RIMN) in the treatment of periprosthetic fractures after total knee arthroplasty (TKA),providing reference for surgeons to select the fixation approach.Methods Cochrane Library,PubMed,Embase,Medline,Wanfang database,VIP Database for Chinese Technical Periodicals,and China National Knowledge Infrastructure (CNKI) were searched to identify the retrospective comparison studies (RCS) which compared the clinical outcomes of LCP and RIMN for patients with periprosthetic supracondylar fractures of the distal femur after TKA.The quality of included literatures was evaluated by Newcastle-Ottawa scale(NOS).Meta-analysis was performed using Revman 5.3 software to compare the operation time,Knee society score (KSS),fracture healing time,nonunion rate,reoperation rate,and incidence of complications between the two groups.Results Ten retrospective comparison studies involving 487 patients were identified including LCP group (296 cases) and RIMN group (191 cases).The meta analysis results showed that no significant differences were found in the operation time (MD =10.89,95％ CI-9.56-31.33,P ＞ 0.05),KSS (MD =1.11,95％ CI-8.88-11.10,P =0.83),fracture healing time (MD =0.00,95％ CI-1.51-1.51,P ＞0.05),nonunion rate (OR =0.71,95％ CI 0.38-1.31,P ＞ 0.05),reoperation rate (OR =0.65,95％ CI 0.22-1.91,P ＞ 0.05),and complication incidence rate (0R=0.69,95％CI0.38-1.26,P＞0.05) between these two groups.Conclusions There are no significant differences in the operation time,KSS,fracture healing time,nonunion rate,reoperation rate,and complications between LCP and RIMN groups.LCP and RIMN have similar clinical outcomes in treating periprosthetic supracondylar femoral fracture following TKA.