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扩髓与非扩髓髓内钉固定术治疗成人股骨干骨折的系统评价
引用本文:廖燚,白靖平,锡林宝勒日,金格勒,李幼平.扩髓与非扩髓髓内钉固定术治疗成人股骨干骨折的系统评价[J].中华骨科杂志,2006,26(6):404-408.
作者姓名:廖燚  白靖平  锡林宝勒日  金格勒  李幼平
作者单位:1. 834000,新疆克拉玛依市中心医院骨科
2. 新疆医科大学附属肿瘤医院
3. 新疆医科大学第一附属医院骨科
4. 四川大学华西医院中国循证医学中心,临床流行病学资源与培训中心
摘    要:目的对扩髓与非扩髓的髓内钉固定术治疗成人股骨干骨折的疗效进行评价。方法按照Cochrane系统评价的方法,计算机检索Medline(1966年至2004年9月)、Embase(1966年至2004年9月)、Cochrane图书馆(2004年第三期)及中国生物医学数据库(1979年至2004年9月),并采用手工检索等方法收集会议文献。文献检索无语种限制。收集所有相关随机对照试验,采用Cochrane协作网提供的软件Revman4.2.3进行Meta分析,以获得扩髓与非扩髓的髓内钉固定术治疗成人股骨干骨折的疗效及其安全性是否有差异的相关证据。结果经全面检索及筛查后,共纳入5个随机对照试验进行评价。Meta分析表明,扩髓髓内钉固定能降低成人股骨干骨折的不愈合率RR=O.38,95%置信区间(0.17,0.88),P=0.02]、内固定失效率RR=0.45,95%置信区间(0.21,1.00,P=0.05]和减少骨折愈合时间WMD=-10.90,95%置信区间(-18.16,-3.64),P=0.003]。结论与非扩髓髓内钉固定相比,扩髓固定能降低成人股骨干骨折的不愈合率。但扩髓与否与内固定失效率、骨折愈合时间、肺部并发症、感染等的关系,以及骨折开放与否、是否合并多发伤及骨折的部位等对上述指标的影响有待于进一步研究。

关 键 词:股骨骨折  骨折固定术  髓内  随机对照试验  Meta分析
收稿时间:2005-05-18
修稿时间:2005-05-18

Systematic review of reamed versus nonreamed intramedullary nailing for femoral fractures in adults
LIAO Yi, BAI Jing-ping, XILIN Bao-le-ri,et al..Systematic review of reamed versus nonreamed intramedullary nailing for femoral fractures in adults[J].Chinese Journal of Orthopaedics,2006,26(6):404-408.
Authors:LIAO Yi  BAI Jing-ping  XILIN Bao-le-ri  
Institution:Department of Orthopaedics, Central Hospital of Xinjiang Kelamayi City, Kelamaryi 834000, China
Abstract:Objective To determine the efficacy and safety of reamed versus nonreamed intramedullary nailing for femoral fractures in adults on the rates of nonunion, the rates of implant failure, the rates of pulmonary implications, infections, the time of union, et al. Methods According to Cochrane Systematic Review, Medline, Embase, Cochrane Library and CBM disc were searched for RCTs without limitation of language, and gray literatures had been also searched, furthermore, the bibliographies of retrieved papers and content experts were consulted for additional references. Methodology quality of literatures used simple evaluate method the Cochrane Collaboration recommended, which was graded to A, B, C. Data was extracted by two reviewers for inclusion using the designed extraction form. Revman 4.2.3 the Cochrane Collaboration provided were used for data management and analysis, and obtained evidences for the efficacy and safety of reamed versus nonreamed intramedullary nailing for femoral fractures in adults. Results Five RCTs were included by total retrieve and riddling. For methodology quality of literatures, one was A scale, two was B, and two was C. The combined results showed that reamed intramedullary nailing for femoral fractures in adults reduce the rates of nonunion RR=0.38, 95% CI(0.17, 0.88), P=0.02 , implant failure RR=0.45,95% CI (0.21,1.00), P=0.05 and the time to union WMD=-10.90,95% CI (-18.16,-3.64), P=0.003 . Conclusion To compare with nonreamed intramedullary nailing for femoral fractures in adults, reamed intramedullary nailing can reduce the rates of nonunion. However, the relation between reaming or not and implant failure, the time to union, pulmonary complications, infection etc needs further study.
Keywords:Femoral fractures  Fracture fixation  intramodullary  Randomized controlled trials  Meta-analysis
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