中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (35): 5715-5723.doi: 10.3969/j.issn.2095-4344.1019

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

微创钢板内固定与传统手术治疗成人肱骨干骨折的系统评价

王 伟1,2,陈永佳3,沈 磊1,陆政峰1,李柳炳1   

  1. 1苏州大学附属第二医院骨外科,江苏省苏州市 215000;2苏州大学医学部,江苏省苏州市 215000;3昆山市第六人民医院骨外科,江苏省昆山市 215300
  • 通讯作者: 李柳炳,副主任医师,苏州大学附属第二医院骨外科,江苏省苏州市 215000
  • 作者简介:王伟,男,1995年生,甘肃省庄浪县人,汉族,苏州大学医学部在读学士,主要从事创伤骨科方向的研究。
  • 基金资助:

    苏州市科技局医疗卫生应用基础研究(SYS201626);苏州市科技局民生科技关键技术项目(SS201764);苏州大学青年教师自然科学基金(SDY2015A19);江苏省高校自然科学研究面上项目(16KJB320009),江苏省青年医学人才基金

Minimally invasive plate osteosynthesis versus traditional surgical method for adult humeral shaft fractures: a meta-analysis  

Wang Wei1, 2, Chen Yongjia3, Shen Lei1, Lu Zhengfeng1, Li Liubing1   

  1. 1Department of Orthopedics, the Second Hospital Affiliated to Soochow University, Suzhou 215000, Jiangsu Province, China; 2Medical College of Soochow University, Suzhou 215000, Jiangsu Province, China; 3Department of Orthopedics, Sixth People’s Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
  • Contact: Li Liubing, Associate chief physician, Department of Orthopedics, the Second Hospital Affiliated to Soochow University, Suzhou 215000, Jiangsu Province, China
  • About author:Wang Wei, Department of Orthopedics, the Second Hospital Affiliated to Soochow University, Suzhou 215000, Jiangsu Province, China; Medical College of Soochow University, Suzhou 215000, Jiangsu Province, China
  • Supported by:

    the Applied Basic Research of Medical Health of Suzhou Science and Technology Bureau, No. SYS201626; the Key Project of People's Livelihood Science and Technology of Suzhou Science and Technology Bureau, No. SS201764; the Natural Science Foundation for the Young Teachers in Soochow University, No. SDY2015A19; the Natural Science Research Project of Jiangsu Provincial Universities, No.16KJB320009; the Youth Medical Talent Foundation of Jiangsu Province

摘要:

文章快速阅读:

 

 

文题释义:
微创钢板内固定技术:技术核心是避免直接暴露骨折端,最大程度地保护骨折碎片活力,使用长接骨板进行桥接固定,为骨折愈合提供良好的生物学环境。间接复位避免骨膜剥离,减少对骨穿支动脉和滋养动脉的破坏,不会对骨膜营养血管造成损害。而良好的血供提高抗感染能力,降低感染机会,减少因手术造成的骨缺失,同时还保留成骨生长因子,降低植骨需求。
肱骨干骨折:系指肱骨外科颈以下1.0-2.0 cm至肱骨髁上2 cm之间的骨折,多发于骨干的中部,其次为下部,上部最少,中下1/3骨折易合并桡神经损伤,下1/3骨折易发生骨不连。常见的手术方式有传统的髓内钉固定和切开复位钢板内固定,以及近几年发展起来的微创钢板内固定技术。
 
摘要
背景:目前,有不少临床研究对比微创钢板内固定技术和传统手术治疗肱骨干骨折的效果,但尚不能确定哪种方法更为优越,因此对2种手术方式的临床疗效进行系统评价很有必要。
目的:系统对比微创钢板内固定技术和传统手术方式(髓内钉固定与切开复位钢板内固定)治疗肱骨干骨折的临床疗效。
方法:电子检索 PubMed、EMBASE、ClinicalTrials.gov、Web of Science、Cochrane和CNKI数据库,时限截止到2018-03-10。2名评价者按纳入排除标准对文献进行独立筛选,通过 RevMan 5.3.5软件完成Meta 分析。

结果与结论:①最终纳入3篇随机对照试验和3篇前瞻性队列研究,共324例患者;②Meta分析结果显示,微创钢板内固定组医源性桡神经损伤发生率比传统组低(RR=0.35,95%CI 0.13-0.96,P=0.87,I²=0%);2组的愈合率、愈合畸形、愈合时间、手术时间、深部和浅部感染、手术失败及术后功能评分差异无显著性意义;③提示与传统手术治疗肱骨干骨折相比,微创钢板内固定仅能降低医源性桡神经损伤的发生率,而术后骨折愈合情况、感染、手术失败及功能评分方面,2种方法无明显差异。今后仍需要大样本的随机对照试验来验证结论。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0002-2121-0619(王伟)

关键词: 肱骨干骨折, 微创钢板接骨术, 髓内钉, 切开复位钢板内固定, Meta分析

Abstract:

BACKGROUND: There are many clinical studies comparing the treatment outcomes of minimally invasive plate osteosynthesis and traditional surgical method for humeral shaft fracture, but which treatment is optimal remains controversial. Therefore, it is necessary to systematically evaluate the curative effect of two kinds of surgical methods.

OBJECTIVE: To compare the clinical outcomes between minimally invasive plate osteosynthesis and conventional fixation techniques (intramedullary nail fixation and open reduction and plate osteosynthesis) for primary humeral shaft fractures surgery.
METHODS: A computer-based search was performed in PubMed, EMBASE, ClinicalTrials. gov, Web of Science, Cochrane and CNKI databases for the articles published prior to March 10, 2018. Two authors screened articles in accordance with inclusion and exclusion criteria independently. Meta-analysis was performed on RevMan 5.3.5 software.
RESULTS AND CONCLUSION: (1) Three randomized controlled trials and three prospective cohort studies were enrolled, involving 324 patients. (2) Meta-analysis results showed that the minimally invasive plate osteosynthesis reduced the incidence of iatrogenic radial nerve injury compared with the conventional fixation techniques (RR=0.35, 95%CI=0.13-0.96, P=0.87, I²=0%). No difference was found in the indices of nonunion, malunion, healing time, operation time, superficial infection, deep infection, implant failure and postoperative functional scores between minimally invasive plate osteosynthesis and conventional fixation techniques. (3) Our results indicate that minimally invasive plate osteosynthesis can reduce the incidence of iatrogenic radial nerve injury compared with conventional fixation techniques. But the healing of fracture, infection, implant failure and functional scores show no significant difference between two methods. Randomized controlled trials with large sample size are needed to confirm these findings.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Humeral Fractures, Surgical Procedures, Minimally Invasive, Internal Fixators, Meta-Analysis, Tissue Engineering

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