钢板内固定和髓内针固定比较治疗成人肱骨干骨折疗效的系统评价

目的系统评价钢板内同定与髓内针固定治疗成人肱骨干骨折的疗效。方法计算机检索PubMed（1950-2007．9）、OVIDMEDLINE（1950-2007．9）、OVIDCINAHL（1950-2007．9）、OVIDEBM（2007年第3季度）、CBMdisc（1978-2007．6），CNKI（1981-2007．6），手T检索《中华外科杂志》等6种巾文主要外科杂志：收集钢板内固定与髓内针同定比较治疗成人肱骨干骨折的随机对照试验（RCT），评价纳入研究的方法学质量，并提取有效数据采用Stata10．0软件进行Meta分析。结果共纳入6个RCT，共425例患者。文献异质性较小（P〉0．1），累积Meta分析结果表明，钢板内固定与髓内针同定比较，在再次手术发生率上，2000年以前（包括2000年）Meta分析结果为钢板内同定可显著降低再次手术发生率[OR=0．39，95％CI（0．17，0.90），P=0．03]，但2000年以后至今，两者再次手术发生率的差异无统计学差异[OR=0．54，95％CI（0.27，1．08），P=0．08：；在肩部撞击发生率上，钢板内同定显著低于髓内针固定[OR=0．13，95％CI（0.03，0.65），P=0.01]。在术后再次手术率、骨折不愈合率、医源性神经损伤、深部感染、内同定失败等方面，两者差异无统计学意义。对于术后骨折愈合时间、手术时间、出血（输血）量上，由于文献未提供详细数据，未能做Meta分析，只是进行描述性分析。结论与钢板内固定相比较，髓内针同定治疗成人肱骨折容易导致肩部撞击的发生。在再次手术发生率、骨折不愈合率、医源性神经损伤、深部感染、内同定失败等方面，两者差异无统计学意义。因本次系统评价纳入病例数较少，尚需要更多设计严谨的大样本随机对照研究来增加证据的论证强度。

Plating versus Intramedullary Nailing of Humeral Shaft Fractures in Adults: A Systematic Review

Objective To compare the efficacy of plating versus intramedullary nailing in the treatment of adult humeral shaft fracture.Methods We identified eligible studies in PubMed(1950 to September 2007),MEDLINE(1950 to September 2007),OVID CINAHL(1950 to September 2007),OVID EBM(3rd Quarter 2007),CBMdisk(1978 to June 2007)and CNKI(1981 to June 2007).We also handsearched several Chinese orthopedic journals.Data were extracted and evaluated by two reviewers independently.Randomized controlled trials(RCTs)comparing plating versus intramedullary nailing for humeral shaft fracture in adults were included and the quality of these trials was critically assessed.Data analyses were conducted with Stata 10.0.Results Six RCTs involving 425 patients were included,among which the statistical heterogeneity was not significant(P>0.1).Cumulative meta-analyses showed that intramedullary nailing might increase the re-operation rate in studies conducted before the year of 2000(OR=0.39,95%CI 0.17 to 0.90,P=0.03),but the difference was not significant in studies conducted after 2000(OR=0.54,95%CI 0.27 to 1.08,P=0.08).Intramedullary nailing might increase the incidence of shoulder impingement compared with plating(OR=0.13,95%CI 0.03 to 0.65,P=0.01).The rates of non-union,deep infection,iatrogenic radial nerve injury and internal fixation failure were similar between plating and intramedullary nailing.Meta-analyses were not conducted for union time,operation time and bleeding(transfusion)volume,because the relevant data were not available from the included trials.Conclusion Intramedullary nailing may increase the incidence of shoulder impingement.The rates of re-operation,non-union,deep infection,iatrogenic radial nerve injury and internal fixation failure are similar between plating and intramedullary nailing.Further well-designed and large-scale randomized controlled trials are required to determine the effects of plating and intramedullary nailing on these outcomes.