中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (53): 8670-8676.doi: 10.3969/j.issn.2095-4344.2015.53.020

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

可膨胀髓内钉与交锁髓内钉修复胫骨骨折的Meta分析

王文达,金 祺,阮文枫,平安松   

  1. 武汉大学中南医院骨科,湖北省武汉市 430071
  • 收稿日期:2015-10-12 出版日期:2015-12-24
  • 作者简介:王文达,男,1990年生,山东省龙口市人,汉族,武汉大学在读硕士,主要从事脊柱疾病、四肢骨折基础与临床方面的研究。

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

Wang Wen-da, Jin Qi, Ruan Wen-feng, Ping An-song   

  1. Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
  • Received:2015-10-12 Online:2015-12-24
  • About author:Wang Wen-da, Studying for master’s degree, Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China

摘要:

背景:目前已有大量研究证实可膨胀髓内钉和交锁髓内钉在修复四肢骨折方面均有确切疗效。但是对于胫骨骨折的治疗,两种内固定方式的优劣尚无定论。
目的:系统评价可膨胀髓内钉与交锁髓内钉置入内固定修复胫骨骨折的安全性及有效性。
方法:计算机检索PubMed、Embase、The Cochrane Library(2015年第1期)、CBM、CNKI、VIP、WanFang Data,检索词包括:tibia,fracture,tibia fracture,tibia fractures,expandable intramedullary nail,expandable nail,intramedullary nail,interlocking intramedullary nail,膨胀,髓内钉,胫骨骨折等。检索时限均为从建库至2015-01-01。查找比较可膨胀髓内钉与交锁髓内钉修复胫骨骨折的随机对照试验。采用RevMan 5.2软件进行Meta分析。
结果与结论:最终纳入10个研究,共574例患者。Meta分析结果显示,与交锁髓内钉相比,可膨胀髓内钉组手术时间更短[MD= -23.42,95%CI (-26.94,-19.90),P < 0.000 01]、术中出血更少[MD=-47.64,95%CI (-52.21,-43.09),P < 0.000 01]、透视次数更少[MD=-1.40,95%CI (-1.49,-1.30),P < 0.000 01]、骨折愈合时间更短[MD=-30.84,95%CI (-35.27,-26.41),P < 0.000 01]、并发症发生率更少[OR=0.20,95%CI (0.10,0.40),P < 0.000 01]。但两组患者治疗后Johner-Wruh评分差异无显著性意义。提示可膨胀髓内钉应用于胫骨骨折的修复效果较交锁髓内钉更具优势,可以说可膨胀髓内钉是对交锁髓内钉的一种改进,但仍需要大样本高质量的随机对照试验进一步证实该结论。 

关键词: 骨科植入物, 骨植入物, 胫骨骨折, 可膨胀髓内钉, 交锁髓内钉, Meta分析, 随机对照试验

Abstract:

BACKGROUND: At present, a large number of studies have proved that the expandable intramedullary nail and interlocking intramedullary nail are effective in treatment of limb fractures. However, for the treatment of tibial fractures, the advantages and disadvantages of the two kinds of fixation methods are still inconclusive.
OBJECTIVE: To systematically review the effectiveness and safety of expandable intramedullary nail and interlocking intramedullary nail for treatment of tibia fracture.
METHODS: We searched PubMed, Embase, The Cochrane Library (Issue 1, 2015), CBM, CNKI, VIP and WanFang Data for articles concerning randomized controlled trials on expandable intramedullary nail versus interlocking intramedullary nail published from inception to January 1, 2015. The key words were “tibia, fracture, tibia fracture, tibia fractures, expandable intramedullary nail, expandable nail, intramedullary nail, interlocking intramedullary nail”. Meta-analysis was performed using RevMan 5.2 software.
RESULTS AND CONCLUSION: Ten randomized controlled trials involving 574 patients were included. The results of meta-analysis showed that, compared with interlocking intramedullary nail, expandable intramedullary nail was shorter in operation time [MD=-23.42, 95%CI (-26.94, -19.90), P < 0.000 01], less in intraoperative hemorrhage [MD=-47.64, 95%CI (-52.21, -43.09), P < 0.000 01], less in fluoroscopy times [MD=-1.40, 95%CI (-1.49, -1.30), P < 0.000 01], shorter in union time [MD=-30.84, 95%CI (-35.27, -26.41), P < 0.000 01], and less in incidence of complications [OR=0.20, 95%CI (0.10, 0.40), P < 0.000 01]. The Johner-Wruh scores showed on significant difference. These findings suggest that expandable intramedullary nail for tibia fracture has more advantages than interlocking intramedullary nail. That is to say, the expandable intramedullary nail is an improved nail of interlocking intramedullary nail, but a large sample of high quality randomized controlled trials are still needed to confirm the conclusion.  

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