钢板和髓内针置入修复成人前臂骨干骨折的Meta分析

Meta-analysis of plating versus intramedullary nailing for forearm shaft fractures in adults

背景:手术固定前臂骨干骨折的方式包括钢板内固定和髓内针内固定。钢板内固定的优点是可以解剖复位,缺点是剥离多,对血供破坏大,手术并发症多,而且容易发生再骨折。髓内针优点是微创,但缺点是控制旋转能力相对较差。前臂骨干骨折钢板内固定和髓内针内固定哪种修复效果更优,目前尚无定论。目的:系统评价钢板内固定与髓内针固定修复成人前臂骨干骨折的疗效。方法:计算机检索PubMed、MEDLINE、CINAHL、EBM、中国生物医学文献数据库、万方数据知识服务平台和中国学术期刊网,手工检索《中华外科杂志》等中文主要外科杂志。收集钢板内固定与髓内针内固定比较修复成人前臂骨干骨折的前瞻性或回顾性对比研究,应用Jadad评价纳入研究的方法学质量,并提取有效数据采用Stata 12.0软件进行Meta分析。结果与结论:共纳入4个临床研究,其中1个前瞻性临床试验,3个回顾性观察研究。无论是主要结局指标的功能评价及并发症,还是次要结局指标的骨折愈合时间、手术时间、前臂旋转活动弧、再骨折、骨不连等方面,钢板内固定组和髓内针内固定组差异均无显著性意义。提示钢板内固定和髓内针内固定修复成人前臂骨干骨折疗效相当,但该研究结果的可靠性仍需要多中心、大样本长期随访的随机对照试验来证实。

BACKGROUND：The ways of surgical fixation of forearm shaft fractures contained plate fixation and intramedul ary nail fixation. The advantage of plate fixation is anatomical reduction. The disadvantage is more peeled tissues, which greatly destroys blood supply and many surgical complications. Moreover, refracture easily appeared. The advantage of intramedul ary nailing is minimal invasion, but disadvantage is poor ability to control the rotation. It remains controversial that plate fixation and intramedul ary nail fixation for forearm shaft fractures which can obtain better repair effects. OBJECTIVE：To systematical y evaluate the efficacy of plate fixation and intramedul ary nail fixation in the repair of forearm shaft fractures in adults. METHODWe retrieved PubMed, MEDLINE, CINAHL, EBM, Chinese BioMedical Literature Database, Wanfang Database and Chinese Academic Journal Network, and retrieved Chinese Journal of Surgery by hand. Prospective or retrospective comparative studies concerning plate fixation versus intramedul ary nailing for forearm shaft fractures were col ected. Jadad was utilized to assess methodological quality of the included studies. Effective data were extracted using Stata 12.0 software for meta-analysis. RESULTS AND CONCLUSION：Total y four clinical trials were included, including one prospective clinical trial and three retrospective observational studies. No significant differences were found in functional outcomes, complications, bone union time, operative time, forearm rotation arc, refracture and nonunion between plate fixation and intramedul ary nail fixation groups. Results indicated that plate fixation and intramedul ary nail fixation in the repair of forearm shaft fractures in adults obtained identical effects. However, the reliability of study results should be verified by randomized control ed trial of multi-center, large-sample and long-period fol ow-up.