弹性髓内钉与外固定架修复儿童股骨干骨折的Meta分析

Meta-analysis of flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures

背景:弹性髓内钉与外固定架修复儿童股骨干骨折是临床常用的两种固定形式,至于选择哪种固定方式更好目前仍存争议。目的:系统评价弹性髓内钉与外固定架修复儿童股骨干骨折的疗效。方法:计算机检索Pub Med、Embase、Medline、Cochrane图书馆数据库,检索时间从建刊至2014年11月25日,检索文献语种无限制。收集国内外公开发表的弹性髓内钉与外固定架修复儿童股骨干骨折的临床对tata 12.0照试验研究,患儿年龄3-15岁,应用改良Jadad方法学评分评价纳入文献的方法学质量,采用S软件进行Meta分析。结果与结论:纳入6篇研究文献,共237例患者。Meta分析显示,与外固定架相比,弹性髓内钉固定后总体并发症[RR=0.30,95%CI:0.19-0.46,P<0.001]与针道感染[RR=0.286,95%CI:0.13-0.61,P=0.001]的发生率较低,针尾激惹[RR=1.86,95%CI:1.35-2.56,P<0.001]的发生率较高,而两组其他指标相比差异无显著性意义。提示与外固定架相比,弹性髓内钉固定具有并发症少,骨折愈合快等优点,对于单纯性儿童股骨干骨折,推荐选择弹性髓内钉固定;而对于下肢高能量损伤、多发伤或伴有严重软组织损伤患者,外固定架是更好的选择。

BACKGROUND：Flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures are two common methods in the clinic. It remains controversial which fixation methods are better. OBJECTIVE：To systematicaly evaluate the therapeutic effects of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures. METHODS： A computer-based search was performed on PubMed, Embase, Medline, and Cochrane library for literatures on clinical controled trials of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures published before November 25, 2014. Literature language was not limited. The age of subjects was from 3 to 15 years. Modified Jadad was utilized to assess methodological quality of the included studies.nbsp;Meta-analysis was carried out using Stata 12.0 software. RESULTS AND CONCLUSION：Six papers involving 237 patients were included. Meta-analysis results showed that compared with external fixation, a low incidence of overal complications [relative risk （RR）=0.30, 95% confidence interval （CI）： 0.19-0.46;P 〈 0.001] and pin-hole infection （RR=0.286, 95%CI： 0.13-0.61;P= 0.001）, but a high risk of needle tail irritation （RR=1.86, 95%CI： 1.35-2.56;P 〈 0.001） were found folowing flexible intramedulary nailing. No significant differences in other complications were found between the two groups. These results confirm that compared with external fixation, elastic intramedulary nail has fewer complications and faster fracture healing. Elastic intramedulary nail is recommended for single pediatric femoral shaft fractures. However, external fixation is a better option for high energy injury of lower limbs, multiple trauma or severely soft tissue injury.