扩髓与非扩髓髓内钉修复成人胫骨干骨折的系统评价

摘要

BACKGROUND:At present, the clinical application of intramedul ary nail in the treatment of tibial shaft fractures has achieved good results. However reamed and unreamed intramedul ary nail in repair of tibial fractures in adults remains controversial. OBJECTIVE:To evaluate clinical efficacy and safety of reamed versus unreamed intramedul ary nailing for the treatment of tibial fractures in adults. METHODS:The literature related to application of reamed or unreamed intramedul ary nailing for tibial fractures published from 1980 to 2015 were searched from Springer, PubMed, and Wanfang database. Related Chinese and English journals of orthopedics were hand-searched. Al randomized control ed trials were col ected. RevMan5.0 provided by Cochrane was used to analyze the data. RESULTS AND CONCLUSION:Seven randomized control ed trials were included according to inclusion criteria, including 1 331 patients. There were 682 cases in the reamed intramedul ary nailing group and 649 cases in the unreamed intramedul ary nailing group. Meta-analysis results showed that compared with the reamed intramedul ary nailing group, implant failure rate was significantly higher in the unreamed intramedul ary nailing group [MD=0.37, 95%CI (0.24, 0.57), P<0.000 01], and nonunion rate was significantly higher [MD=0.54, 95%CI (0.31, 0.93), P=0.03]. There was no significant difference in the incidence of compartment syndrome, the rate of malunion and postoperative infection rate. Results suggested that no difference in the incidence of compartment syndrome, the rate of malunion and postoperative infection rate was found in reamed and unreamed intramedul ary nailing in the repair of adult tibial fractures. Reamed intramedul ary nailing has advantages of low implant failure rate and nonunion rate.%背景：目前临床使用髓内钉修复胫骨干骨折取得了良好效果，但针对扩髓与非扩髓髓内钉修复成人胫骨骨折仍存在争议。目的：系统评价扩髓与非扩髓髓内钉修复成人胫骨干骨折的临床疗效及安全性。方法：计算机检索1980至2015年Springer、Pubmed及万方等数据库，手工检索中英文骨科杂志，收集所有对扩髓与非扩髓髓内钉治疗成人胫骨干骨折疗效进行比较的随机对照试验，利用Cochrane协作网提供的RevMan5.0软件进行Meta分析。结果与结论：纳入符合标准的随机对照研究7篇，共1331例患者，其中扩髓组682例，非扩髓组649例。Meta分析结果显示，与扩髓组相比，非扩髓组内置物失效率显著升高[MD=0.37，95%CI(0.24，0.57)，P<0.00001]，骨折不愈合率显著升高[MD=0.54，95%CI(0.31，0.93)，P=0.03]；两组骨筋膜室综合征发生率、畸形愈合率、术后感染率比较差异无显著性意义。结果表明，扩髓与非扩髓髓内钉修复成人胫骨干骨折的骨筋膜室综合征发生率、畸形愈合率及术后感染率无差异，但扩髓髓内钉具有内置物失效率和骨折不愈合率低等优点。