扩髓与不扩髓条件下髓内钉置入内固定治疗成人股骨干骨折的系统评价

背景：髓内钉扩髓与不扩髓治疗股骨干骨折仍存在争议。 目的：比较扩髓与不扩髓髓内钉治疗股骨干骨折的临床效果,评价两种治疗方法的疗效差异。 方法：计算机检索Cochrane图书馆(2011年第9期)、MEDLINE(1966-01/2011-09)、EMbase(1984-01/2011-09)、CNKI(1979-01/2011-09)等数据库,收集比较扩髓和不扩髓治疗股骨干骨折的随机对照试验,利用Cochrane 协作网提供的RevMan5.1.2软件对纳入研究结果进行Meta 分析,使用GRADEpro version3.2.2软件对纳入研究进行证据评级。 结果与结论：纳入10个随机对照试验,共1 360例股骨干骨折患者,其中扩随组 656例,不扩髓组704例。Meta分析表明,与不扩髓髓内钉相比,扩髓髓内钉固定能降低成人股骨干骨折不愈合率(RR = 0.20,95%CI 0.07~0.82,P=0.02)、再次手术率(RR=0.25,95%CI 0.11~0.59,P=0.002)、延迟愈合率(RR = 0.30,95%CI 0.14~0.64,P=0.002)等,对于内固定失败率(RR=0.68, 95% CI 0.28~1.70,P = 0.41)、病死率(RR 0.94, 95% CI 0.19~4.58,P=0.94)、呼吸窘迫综合征发生率(RR 1.53,95% CI 0.37~6.32, P=0.78)差异无显著性意义。结果提示扩髓髓内钉比不扩髓髓内钉治疗成人股骨干骨折有较好的临床疗效。

Systematic review of reamed intramedullary nailing versus unreamed intramedullary nailing for femoral shaft fractures in adult patients

BACKGROUND:Reamed intramedullary nailing and unreamed intramedullary nailing for the treatment of femoral shaft fractures is still controversial. OBJECTIVE:To compare the clinical effects of reamed intramedullary nailing versus unreamed intramedullary nailing for femoral shaft fracture and to evaluate the efficiency differences between the two methods. METHODS:Cochrane central register of controlled trials (No.9 in 2011), Medline (1966-01/2011-09), EMbase (1984-01/2011-09) and CNKI (1979-01/2011-09) were searched by computer for randomized controlled trials (RCTs) that related to reamed intramedullary nailing versus unreamed intramedullary nailing for shaft fracture of femur in the adults. Meta-analysis was performed with software RevMan5.1.2 from the Cochrane collaboration. The study was graded by GRADEpro version3.2.2 software. RESULTS AND CONCLUSION:Ten RCTs with 1 360 femoral shaft fractures were included containing reamed intramedullary nailing (656 cases) and unreamed intramedullary nailing (704 cases). The Meta-analysis showed that compared with unreamed intramedullary nailing, reamed intramedullary nailing for femoral shift fractures could reduce the nonunion rate (RR=0.20, 95% CI 0.07-0.82, P = 0.02), re-operation rate (RR=0.25, 95% CI 0.11-0.59, P = 0.002) and delayed healing rate (RR=0.30, 95%CI 0.14-0.64, P = 0.002), for the fixation failure rate (RR = 0.68, 95% CI 0.28-1.70, P = 0.41), mortality rate (RR 0.94, 95% CI 0.19-4.58, P = 0.94) and incidence rate of respiratory distress syndrome (RR 1.53, 95% CI 0.37-6.32, P = 0.78) had no significant statistical difference. It is indicated that reamed intramedullary nailing has better clinical effects than unreamed intramedullary nailing for femoral shaft fracture in the adults.