胸部创伤伴股骨骨折髓内钉与钢板治疗的系统评价

Intramedullary nailing versus plate for treatment of femoral fracture combined with thoracic injury: a systematic review

目的对髓内钉与钢板治疗股骨骨折合并胸部损伤患者的肺部并发症、重症监护时间及死亡风险进行系统评价。方法计算机检索EMBASE、PUBMED、OVID、Cochrane协作网肌骨创伤组实验数据库、CNKI、万方数据库等,并辅以手工检索,收集所有关于髓内钉与钢板治疗股骨骨折合并胸部损伤患者的临床随机对照试验(RCT),根据Jadad量表评价纳入研究的方法学质量,并采用RevMan 5.0对结果进行Meta分析。结果共纳入2组研究,包括263例股骨骨折合并胸部损伤患者。Meta分析结果显示,髓内钉与钢板内固定相比,肺部并发症发生率[RR=0.339,5%CI=(0.025,.82),P=0.45]、死亡风险[RR=1.36,95%CI=(0.19,9.76),P=0.76]以及重症监护时间[MD=-2.00,95%CI=(-10.77,6.76),P=0.65]差异并无统计学意义。结论对于股骨骨折合并胸部创伤的多发伤患者,骨折内固定方法的选择不会影响其肺部并发症发生率、死亡风险及重症监护时间,但由于纳入的随机对照临床试验较少,结果可能存在一定的偏倚,尚需临床观察进一步证实。

Objective To compare pulmonary complication and mortality as well as ICU days of intramedullary nailing and plate for treatment of femoral fracture combined with thoracic injury.Methods The electronic databases（EMbase,PubMed,OVID,Cochrane center of controlled Trials,CNKI and Wan Fang database） were searched in order to retrieve randomized controlled trials（RCTs） about comparing intramedullary nailing and plate for treatment of femoral fracture combined with thoracic injury.In addition,reference lists from original studies and review articles were hand searched.The Jadad＇s scale and Cochrane collabration＇s RevMan 5.0 software were used for assessing trial methodological quality and data analysis.Results Two RCTs were included.There were 263 patients that met inclusion criteria in all studies.Results of meta-analysis showed no significant differences in pulmonary complication,mortality and ICU days between patients treated by intramedullary nailing or plate.Conclusion The internal fixation methods selected for patients with femoral fracture combined with chest injury will not affect the incidence of pulmonary complication,mortality and ICU days.However,further-confirmation is required due to shortage of more strict clinical randomized controlled trials.