钢板内固定和髓内钉固定治疗肱骨干骨折的系统评价

Plating versus intramedullary nailing for humeral shaft fractures:a systematic review

[目的]对钢板内固定与髓内钉固定治疗成人肱骨干骨折的疗效进行系统评价。[方法]在Pubmed、Cochrane Library、EMBASE、Science Direct以及CNKI、CBM、中国医学学术会议论文数据库等网站进行检索。文献检索起止时间为1995年1月～2010年9月。再对入选文献的参考文献进行手工检索。系统收集钢板内固定和髓内钉固定治疗肱骨干骨折的相关文献,并按临床科研方法的国际通用原则进行阅读和评价。采用Cochrane协作网提供的软件Revman 4.2进行Meta-分析,以获得钢板内固定和髓内钉固定治疗肱骨干骨折的疗效及其安全性指标的相关证据。[结果]共检索到192篇原始文献,有6篇符合最终的入选标准,总计随访患者335例。Meta分析结果表明,钢板内固定与髓内钉固定比较,可显著降低再次手术发生率但是增加术后感染率。[结论]钢板内固定可显著降低再次手术发生率但是增加术后感染率。在骨折不愈合率、医源性神经损伤等方面,两者差异无统计学意义。因本次系统评价纳入病例数较少,尚需要更多设计严谨的大样本随机对照研究来增加证据的论证强度。

[ Objective I A systematic review was conducted to assess the effectiveness of plating versus intramedullary nailing in the treatment of adult humeral shaft fracture. [ Method ] Using PubMed, Cochrane Library, EMBASE, Science Direct, CNKI, CBM and CM AC, the authar performed a literature search for all the studies published in the English and Chinese languages from january 1995 to March 2010,reporting patients undergoing plating or intramedullary nailing. The bibliographic sections of identi- fied papers were manually searched to identify additional papers. The Revman 4.2 provided by the Cochrane Collaboration was used for management and analysis. Meticulous data extraction and meta analysis was performed according to a preset protocol. [ Result j In 192 citations initially identified,6 eligible papers,which included 335 followed-up patients,met all the final criteria. Meta-analyses showed that plating might decrease re-operation rate but increase infection compared with intramedullary nailing. [ Conclusion ] plating may decrease re-operation rate but increase infection compared with intramedullary nailing. The rates of non-union, iatrogenic radial nerve injury are similar between plating and intramedullary nailing. Further well-designed and largescale randomized controlled trials are required to determine the effects of plating and intramedullary nailing on these outcomes.