扩髓与非扩髓髓内钉置入固定治疗成人闭合性胫骨干骨折的Meta分析

背景：一些对照研究试图回答扩髓与非扩髓髓内钉治疗胫骨闭合性骨折的优劣问题,得出结论各不相同。目的：对成人闭合性胫骨干骨折扩髓与非扩髓髓内钉固定的疗效进行Meta分析。方法：计算机检索PubMed、Embase、Cochrane图书馆及中国生物医学数据库、维普信息数据库、万方数据库。收集扩髓与非扩髓髓内钉固定相比较治疗成人闭合性胫骨干骨折的随机对照试验,并评价纳入研究的方法学质量。统计软件用Cochrane协作网提供的RevMan5.0。结果与结论：共纳入3个随机对照临床试验。Meta分析表明,扩髓髓内钉与非扩髓髓内钉固定治疗成人胫骨干骨折比较,其骨折不愈合率降低[RR0.25,95%CI（0.08,0.79）,P=0.02],内置物失效率显著降低[RR0.25,95%CI（0.12,0.52）P=0.0002]。说明与非扩髓髓内钉固定相比较,扩髓髓内钉固定治疗成人闭合性胫骨干骨折时骨折不愈合率及内置物失效更少见。扩髓与否在骨折延迟愈合率、畸形愈合率、骨筋膜室综合征发生率方面差异无显著性意义。

Meta analysis of reamed versus non-reamed intramedullary nailing for closed tibial fractures in adults

BACKGROUND：Some control studies attempt to answer the advantages and disadvantages of the issue on reamed and non-reamed intramedullary nailing for closed tibial fractures,but the conclusions are different.OBJECTIVE：To determine the efficiency and safety of reamed versus non-reamed intramedullary nailing for closed tibial fractures in adults by Meta analysis.METHODS：PubMed,Embase,Cochranel Library,CBMdisc,Weipu information database and Wanfang were searched by computer.Randomized controlled trials related to reamed versus non-reamed intramedulary nailing for closed tibial fractures in adults were included.The quality of trials was critically assessed.RevMan 5.0 software was used for data analysis.RESULTS AND CONCLUSION：Three randomized controlled trials were included.Meta analysis showed that compared with the non-reamed intramedulary nailing for closed tibial fractures in adults,the nonunion rate decreased [RR 0.25,95%CI（0.08,0.79）,P=0.02] and implant failure rate decreased significantly [RR 0.25,95%CI（0.12,0.52） P=0.000 2] in the reamed intramedullary nailing for closed tibial fractures in adults.Compared with non-reamed intramedulary nailing for closed tibial fractures in adults,reamed intramedulary nailing decreases the nonunion rate and implant failure are rare.There is no statistical difference in the rate of delayed fracture healing,malunion rate and the incidence of compartment syndrome.