胫骨平台骨折术后关节炎危险因素的荟萃分析

Risk factors related to postoperative arthritis of tibial plateau fractures: a meta-analysis

摘要:

[目的]分析胫骨平台骨折术后创伤性关节炎的危险因素。[方法]计算机检索建库至 2022 年 10 月万方、中国生物医学文献数据库、中国知网、PubMed、Embase、Cochrane Library 等，使用 RevMan 5.3 对纳入文献进行荟萃分析。[结果]共纳入 12 篇文献，其中前瞻性研究 1 篇，回顾性研究 11 篇，研究中关节炎患者 338 例，非关节炎患者 1 038 例。荟萃分析结果显示，高能量损伤（OR=3.50，95%CI：2.44~5.03，P＜0.001）、骨折分型≥Ⅳ型（OR=3.86，95%CI：2.60~5.73，P＜0.001）、骨质疏松 （OR=2.63，95%CI 1.04~6.65，P=0.04）、半月板损伤 （OR=1.74，95%CI 1.08~2.81，P=0.02）、受伤至手术时间＞7 d （OR= 2.95，95%CI 2.02~4.30，P＜0.001）、术中骨折非解剖复位（OR=5.92，95%CI 2.73~12.84，P＜0.001）、术后骨折复位解剖学评分差 （OR=10.67，95%CI 2.12~53.77，P=0.004）、机械轴对准不良（OR=2.85，95%CI 1.12~7.26，P=0.03）是胫骨平台骨折术后创伤性关节炎危险因素。[结论]高能量损伤、胫骨平台骨折分型≥Ⅳ型、骨质疏松、合并半月板损伤、受伤至手术时间＞7 d、术中骨折非解剖复位、术后骨折复位解剖学评分差、机械轴对准不良≥5°是胫骨平台骨折术后创伤性关节炎危险因素。对具有以上危险因素的患者应予高度关注及早期干预，降低术后关节炎发生率，改善患者的临床预后。

Abstract:

[Objective] To evaluate the risk factors of traumatic arthritis after surgical treatment of tibial plateau fractures. [Methods] The data bases, including Wanfang、SinoMed、CNKI、PubMed、Embase and Cochrane Library were searched for the papers that met the criteria by computer from the creating to October 2022. The risk factors of traumatic arthritis after surgical treatment of tibial plateau frac- tures were analyzed by using RevMan 5.3. [Results] A total of 12 articles were included, including 1 prospective study and 11 retrospective studies, with 338 arthritic patients and 1 038 non-arthritic patients in the study. As results of the meta-analysis, the high-energy injury (OR=3.50, 95%CI 2.44~5.03, P＜0.001), fracture type ≥ IV (OR=3.86, 95%CI 2.60~5.73, P＜0.001), osteoporosis (OR=2.63, 95%CI 1.04~ 6.65, P=0.04), meniscus injury (OR=1.74, 95%CI 1.08~2.81, P=0.02), time elapsed between injury and surgery ＞7 days (OR=2.95, 95%CI 2.02~4.30, P＜0.001), non-anatomical reduction of the fractures intraoperatively (OR=5.92, 95%CI 2.73~12.84, P＜0.001), poor postopera- tive fracture reduction anatomical score (OR=10.67, 95%CI 2.12~53.77, P=0.004), and mechanical axis malalignment ≥ 5° (OR=2.85, 95% CI 1.12~7.26, P=0.03) were risk factors for postoperative traumatic arthritis of tibial plateau fractures. [Conclusion] The high energy injury, tibial plateau fracture type ≥ IV, osteoporosis, meniscus injury, time elapsed between injury and operation ＞7 days, non-anatomical reduc- tion intraoperatively, poor anatomical score of postoperative fracture reduction, and malalignment of mechanical axis ≥5° are risk factors for traumatic arthritis after tibial plateau fracture surgery. Patients with the above risk factors should be given high attention and early interven- tion to reduce the incidence of postoperative arthritis and improve the clinical prognosis of patients.