Effectiveness of percutaneous iliosacral screwing versus reconstruction plating for treatment of pelvic posterior ring fractures of Tile C: a Meta analysis / 中华创伤骨科杂志

ABSTRACT

Objective To assess the clinical efficacy of percutaneous iliosacral screwing versus reconstruction plating in the treatment of pelvic posterior ring fractures of Tile C.Methods The authors retrieved the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing percutaneous iliosacral screwing versus reconstruction plating for Tile C pelvic posterior ring fractures from the Cochrane library,Medline,Embase,CNKI,Wanfang Data and Chinese Biomedical Database by computer and from major Chinese orthopedic journals by hand.Qualified data were extracted by statistical software Revman 5.2 for meta-analysis.Results 334 cases were included in this Meta-analysis from one RCT and 3 CCTs.Of them,162 underwent percutaneous iliosacral screwing and 172 reconstruction plating (including 66 cases of percutaneous reconstruction plating and 106 ones of anterior reconstruction plating).There was no significant difference between percutaneous iliosacral screwing and reconstruction plating in operation time (P =0.16).Percutaneous reconstruction plating consumed significantly less operation time than anterior reconstruction plating (P ＜ 0.001).Percutaneous iliosacral screwing decreased significantly incision length and intraoperative blood loss than both methods of reconstruction plating (P ＜ 0.001),but significantly increased times of X-ray exposure than percutaneous reconstruction plating (P ＜ 0.001).There were no significantly differences in the good to excellence rates by Matta scores and Majeed scores between percutaneous iliosacral screwing and percutaneous reconstruction plating (P ＞ 0.05),but percutaneous iliosacral screwing performed significantly better than anterior reconstruction plating (P ＜ 0.001).Percutaneous reconstruction plating led to significantly fewer postoperative complications than anterior reconstruction plating (P ＜ 0.001) but similar incidence of postoperative pain at the sacroiliac joint compared with percutaneous reconstruction plating (P =0.30).Conclusion Compared with anterior reconstruction plating,pereutaneous iliosacral screwing and percutaneous reconstruction plating may lead to better clinical efficacy and fewer complications.Percutaneous iliosacral screwing may be superior in incision length and intraoperative blood loss,but it requires more intraoperative X-ray exposure and more demanding technical skills.