可延长髓内钉治疗儿童成骨不全下肢骨折效果的Meta分析

Efficacy of elongating intramedullary rods for lower extremity fractures in osteogenesis imperfecta children: a meta-analysis

目的针对可延长髓内钉治疗儿童成骨不全下肢骨折的相关文献进行Meta分析,对该内固定方法的安全性进行系统评价。方法检索Pub Med、Em Base、Cochrane图书馆、万方数据资源系统、中国期刊网全文数据库中有关可延长髓内钉治疗成骨不全(osteogenesis imperfecta,OI)患儿下肢骨折的文献,筛选后将文献中报道的随访结果相关数据进行提取,采用Stata10. 0进行Meta分析。结果最终纳入的文献共8篇,研究对象为258例经可延长髓内固定的OI患儿下肢骨,其中股骨157例,胫骨101例;患儿年龄范围为3. 1～8. 0岁,术后随访时间为17～228个月。合并分析后得出术后钉相关并发症发生率为25. 00%(95%CI:15. 00%～34. 00%),主要为钉移位,Egger和Begg检验结果显示无发表偏倚(P_(Egger)=0. 248,P_(Begg)=0. 386);骨相关并发症发生率为16. 00%(95%CI:9. 00%～23. 00%),主要为再骨折,Egger和Begg检验结果显示可能存在发表偏倚(P_(Egger)=0. 040,P_(Begg)=0. 086);而再手术率的研究分析得出其发生率约23. 00%(95%CI:12. 00%～35. 00%),Egger和Begg检验结果显示无发表偏倚(P_(Egger)=0. 734,P_(Begg)=0. 806)。结论钉移位和再骨折是可延长髓内钉治疗OI患儿下肢骨折术后的主要并发症,但与非延长髓内钉治疗组相比发生率显著降低,随着内固定系统的不断完善,该手术方法将帮助OI患儿获得更好的生活质量。

Objective To evaluate the safety profile of elongating intramedullary rods for lower extremity fractures in osteogenesis imperfect( OI) children to provide rationales for future application in China. Methods We systematically searched the electronic databases of Pub Med,Em Base,Cochrane library,Wanfang Data Resource System of Digital Periodicals and Chinese Journal Full text Database with the inception of January2018. All processes followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses( PRISMA). And inclusion and exclusion standards were implemented. The summary results were calculated by a random effect model. Results A total of 8 studies were included into the final cohort. There were 258 lower extremities using the elongating intramedullary rod approach. The mean age was 3. 1-8. 0 years and the follow-up period 17-228 months. The rate of rod-related complications was 25. 00%( 95% CI: 15. 00%-34. 00%) and most cases were related with rod migration( 13. 54%). Egger and Begg tests showed no significant publication bias( PEgger: 0. 248;PBegg: 0. 386). The rate of bone-related complications was 16. 00%( 95% CI: 9. 00%-23. 00%) and refractures were predominant( 8. 43%). However,Egger and Begg tests showed significant publication bias( PEgger: 0. 040;PBegg: 0. 086). The reoperative rate was 23. 00%( 95% CI: 12. 00%-35. 00%).And Egger and Begg tests also showed no significant publication bias( PEgger: 0. 734;PBegg: 0. 806). Conclusion During elongating intramedullary rod in OI surgery,rod migration and refracture remain two major postoperative complications. However,comparing with nonelongating intramedullary rodding,the efficacy has obviously improved. With constant development of surgical technique and internal fixation system,this procedure offers a better life quality.