Interlocking Intramedullary Nailversus Minimally Invasive Percutaneous Plate Osteosynthesis For The Treatment Of Distal Extra-articular Tibial Fractures:a Meta-analysis

Objective:By studying the Meta-analysis of two minimally invasive techniques for the treatment of distal extra-articular tibial fractures,evaluating the difference in clinical efficacy of two minimally invasive techniques for the treatment of distal extra-articular tibial fractures,eventually offering more adequate evidence for the treatment of distal extra-articular tibial fractures clinically.Methods:The data bases used by us included CBM,CNKI,Wanfang Data and other Chinese data bases,and PubMed,Embase,BIOSIS,Ovid Databases and other foreign data bases,and manual reserching and reading of relevant Chinese and English magazines and literatures,the retrievalling time is set from January 1,2006 to July 1,2016.Collecting literatures studying about clinical effect of interlocking intramedullary nail versus minimally invasive percutaneous plate osteosynthesis for the treatment of distal extra-articular tibial fractures published at home and abroad.Then,strickly assessing the quality of revelent literatures choiced according to evaluation methods Joni proposed,selecting operation time,time to union,malunion,delayed union,ununion and soft tissue infection or necrosis as outcome evaluation index,extracting revelent datas,and finally making Meta-analysis to extracted datas by using statistical software of RevMan5.3.0.Results:Eventually nine literatures were enrolled(five randomized controlled trial literatures),including 3 Chinese literatures and 6 English literatures,totally comprising656 patients of fractures,and 312 cases in IMN group and 344 cases in MIPPO group.According to the improved Jadad scale standard:five literatures is level A and four is level B.Meta-analysis showed that there are all no statistical differences in operation time,time to union,delayed union and ununion between groups;IMN group is higher than MIPPO group in malunion and there is a statistical difference[RR=2.22,95%(1.40,3.52),P=0.0007];As for sofe tissue infection or necrosis,MIPPO group is higher than IMN and the difference have a statistical signifinance[RR=0.42,95%(0.20,0.89),P=0.02].Conclusion:IMN and MIPPO are still common operation treatment methods for distal extra-articular tibial fractures so far,but it is still controversial to conclude which operation method is more scientific and reasonable presently.When distal tibia fractures was made and the damage of soft tissue is serious,we recommend that IMN should be used to treat;And we advice that fractures should be fixed by using MIPPO when slight damage of soft tissue and instable distal tibial fractures.