钢板内固定与髓内钉治疗肱骨干骨折的Meta分析

Plating versus intramedullary nailing for humeral shaft fractures: a meta- analysis from current literature

[目的]利用Meta分析研究比较钢板内固定与髓内钉固定(intramedullary nailing,IMN)治疗肱骨干骨折的临床疗效。[方法]计算机检索Cochrane骨科组,关节与肌肉创伤组,Cochrane图书馆,MEDLINE数据库,EMBASE数据库,OVID数据库以及谷歌学术2014年10月31日之前所有已发表的关于钢板固定与髓内钉固定治疗肱骨干骨折的文献,并评价纳入研究的方法学质量。文献评价以及数据提取由2名研究员独立完成。[结果]共纳入10篇完全随机对照试验(RCTs)文献和3篇半随机对照试验(quasi-RCTs)文章,共544例患者。通过与髓内钉固定比较,研究结果显示钢板内固定治疗组的再手术率、骨折延迟愈合、肩关节活动受限明显较低,但术后总体感染率高于髓内钉组。另外,两种手术方式的骨折不愈合、深部感染、桡神经损伤、医源性骨折及内固定失败发生情况差异并无明显统计学意义。[结论]结果显示通过钢板内固定手术治疗肱骨干骨折的疗效优于髓内钉内固定。但由于纳入的新文献质量并不高,有待更高质量的完全随机对照研究来进一步证实这个结果。

[Objective]To evaluate and compare the effects of plate versus intramedullary nail in treating the humeral shaft fracture. [Method]Electronic database were searched before October 31,2014 by two independent reviewers,including Cochrane Bone,Cochrane Library,Joint and Muscle Trauma Group,MEDLINE,EMBASE,OVID; and Google Scholar. The Review Manager 5. 1 software was used for Meta- analyze. [Result]Ten randomized controlled trials（ RCTs） and three quasi- RCTs were included,544 participants in all. The current results showed that plate fixation,compared with intramedullary nail fixation,was associated with significantly lower risk of re- operation,delayed union,and restriction of shoulder motion,but higher rate of total infection. Besides,there were no significant differences in nonunion,deep infection,radial nerve palsy,iatrogenic fracture,and implant failure between two interventions. [Conclusion]Based on present evidence,surgical treatment with plate fixation is superior to intramedullary nail fixation regarding the overall therapeutic effect. However,more high quality,randomized controlled studies are still needed to prove this conclusion.