可膨胀髓内钉与交锁髓内钉修复股骨干骨折的Meta分析

文题释义： 可膨胀髓内钉：该髓内钉的主体部分由合金柱状薄管和4根径向辐条组成，其远端呈圆锥形，近端带内螺纹口，内设单项阀门，通过压力泵向钉体内压注生理盐水使髓内钉顺应髓腔的形状膨胀。 交锁髓内钉：它由髓内钉和交锁钉所构成，在其主干的不同方向上可有钻孔，钻孔的直径小于髓内钉的直径，钻孔内可安装不同直径的交锁钉，其具有足够的抗压、抗弯、抗拉强度，应用于骨折术或矫形术中可加快骨折愈合。 背景：大量研究证实可膨胀髓内钉和交锁髓内钉修复四肢骨折方面具有良好的疗效，但2种固定方式治疗股骨干骨折的的优劣尚不明确。 目的：系统评价可膨胀髓内钉与交锁髓内钉修复股骨干骨折的安全性及有效性。 方法：应用计算机检索PubMed、Web of Science、EBSCO、The Cochrane Library、CNKI、VIP、WANFANG Data数据库，查找可膨胀髓内钉与交锁髓内钉修复股骨干骨折的临床对照试验。按严格纳入标准筛选文献，并对最终纳入文献进行研究质量评估，提取数据资料，采用Stata13.0软件进行Meta分析。 结果与结论：①最终纳入7篇文献，其中3篇为随机对照研究，4篇为非随机对照研究，共计492例患者，可膨胀髓内钉组、交锁髓内钉组各246例；②Meta分析结果显示，可膨胀髓内钉组的骨折愈合时间、手术时间、透视时间、住院时间短于交锁髓内钉组SMD=-0.87，95%CI(-1.20，-0.54)，P=0；SMD=-2.45，95%CI(-3.33，-1.58)，P=0；SMD=-2.83，95%CI(-3.68，-1.97)，P=0；SMD=-0.96，95%CI(-1.73，-0.18)，P=0.016]，术中出血量少于交锁髓内钉组SMD=-4.12，95%CI(-6.38，-1.87)，P=0]，在骨不连或延迟愈合率、总体并发症发生率方面无足够数据证实两组间有显著差异；③结果表明，运用可膨胀髓内钉治疗股骨干骨折的手术实施过程较交锁髓内钉更具优势，而对于术后恢复情况两者相当。限于该研究方法学质量影响，未能考虑骨折类型和扩髓等干扰因素，结果还需谨慎对待，尚需要更多大样本、多中心随机对照试验进一步证实。 ORCID: 000-0002-6736-3485(王维) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of femoral shaft fracture

BACKGROUND: A large number of studies have confirmed that expandable intramedullary nails and interlocking intramedullary nails have a good effect in repairing limb fractures. However, for the treatment of femoral shaft fractures, the advantages and disadvantages of the two kinds of fixation methods are not inconclusive. OBJECTIVE: To systematically review the safety and effectiveness of expandable intramedullary nail and interlocking intramedullary nail for treatment of femoral shaft fracture. METHODS: A computer-based online search was conducted in PubMed, Web of Science, EBSCO, The Cochrane Library, CNKI, VIP and Wanfang databases to screen the relevant clinical controlled trials of expandable intramedullary nail versus interlocking intramedullary nail for the treatment of femoral shaft fractures. Two reviewers screened the literature according to the strict inclusion criteria, and assessed the research quality of the finally included literatures, and extracted the data. Meta-analysis was performed using Stata 13.0 software. RESULTS AND CONCLUSION:(1) A total of 7 studies(3 randomized controlled and 4 non-randomized controlled trials) were included, involving 492 patients. Expandable intramedullary nailing group contained 246 patients. Interlocking intramedullary nailing contained 246 patients.(2) The results of meta-analysis showed that compared with the interlocking intramedullary nailing group, fracture healing time, operation time, fluoroscopy time and hospital stay were shorter in the expandable intramedullary nailing group SMD=-0.87, 95%CI(-1.20,-0.54), P=0;SMD=-2.45, 95%CI(-3.33,-1.58), P=0;SMD=-2.83, 95%CI(-3.68,-1.97), P=0;SMD=-0.96, 95%CI(-1.73,-0.18), P=0.016]. Intraoperative blood loss was less in the expandable intramedullary nailing group than that in the interlocking intramedullary nailing group SMD=-4.12, 95%CI(-6.38,-1.87), P=0]. There was no significant difference in the rate of bone nonunion or delayed healing and the overall incidence of complications between the two groups.(3) Therefore, we theoretically believe that expandable intramedullary nailing is more advantageous than interlocking intramedullary nailing in the treatment of femoral shaft fractures, but the postoperative recovery is similar. Limited to the quality of the methodology of this study, it fails to consider the effect of the type of fracture and the interference of the field. The results need to be treated with caution, and more randomized controlled trials are needed to confirm.