顺行与逆行髓内钉治疗股骨远段关节外骨折疗效的Meta分析

Efficacy of anterograde and retrograde intramedullary nails in the treatment of distal femoral extraarticular fracture:a meta-analysis

目的:目前针对于股骨远段关节外骨折,修复时采用顺行或逆行髓内钉还存在一定的争议。因此,文章系统评价了顺行与逆行髓内钉修复成人股骨干远段关节外骨折的疗效及安全性差异。方法:计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、Sciencedirect、Scopus、中国知网、中国生物医学文献服务系统、万方数字化期刊全文数据库、维普中文科技期刊数据库和谷歌学术数据库,收集国内外关于成年人股骨干远段骨折行顺行与逆行髓内钉修复的临床随机对照试验,提取纳入研究的基本资料、出院髋关节Harris评分、骨不连、骨折愈合时间、膝关节疼痛、手术时间、术中失血量和髋部异位骨化等数据资料,使用Cochrane手册风险评估工具对其进行质量评价分析,并采用RevMan 5.3软件对纳入研究结果进行Meta分析。结果:纳入10个较高质量的临床随机对照试验,共757例患者,其中逆行组370例,顺行组387例。逆行组与顺行组患者的手术时间、术中失血量和骨折愈合时间、膝关节疼痛及髋部异位骨化差异均无显著性意义(P>0.05)。与顺行组相比,逆行组患者出院后髋关节Harris评分优良例数增加(RR=1.22,95%CI:1.04-1.45,P=0.02),骨不连发生率降低(RR=0.37,95%CI:0.14-0.96,P=0.04)。结论:现有的10个随机对照试验证据表明,采用逆行髓内钉修复股骨干远段关节外骨折在髋关节功能恢复和骨折愈合方面均优于顺行髓内钉,因此逆行髓内钉治疗股骨干远段骨折有一定优势。

OBJECTIVE:Currently,there is some controversy regarding the use of anterograde or retrograde intramedullary nails for extrararticular fractures of the distal femor.Therefore,this article systematically evaluated the difference in the efficacy and safety of anterograde and retrograde intramedullary nailing in the treatment of distal femoral extrararticular fractures.METHODS:The databases,including PubMed,Web of Science,The Cochrane Library,EMbase,Sciencedirect,Scopus,China National Knowledge Infrastructure,Chinese BioMedical Literature System,Wanfang Data,VIP database for Chinese Technical Periodicals,and Google Scholar were searched through Internet to collect clinical randomized controlled trials of antegrade and retrograde intramedullary nails for distal femoral fractures in adults at home and abroad.The basic data included in the study including the Harris score at the time of discharge,bone nonunion,fracture healing time,knee pain,operation time,intraoperative blood loss,and heterotopic ossification of the hip joints were extracted.The quality evaluation and analysis were conducted using Cochrane Handbook.The results of the included study were meta-analyzed by RevMan 5.3 software.RESULTS:Ten randomized controlled clinical trials were included,with a total of 757 fractures,including 370 cases in the retrograde intramedullary nail group and 387 cases in the antegrade intramedullary nail group.There were no statistically significant differences in operation time,intraoperative blood loss,fracture healing time,knee pain and heterotopic ossification of the hip joints between retrograde intramedullary nails and antegrade intramedullary nails(P>0.05).At the time of discharge,the hip joints Harris score showed that the retrograde intramedullary nail group was superior to the antegrade intramedullary nail group(RR=1.22,95%CI:1.04-1.45,P=0.02).The incidence of bone nonunion in retrograde intramedullary nail group was lower than that in antegrade intramedullary nail group(RR=0.37,95%CI:0.14-0.96,P=0.04).CONCLUSION:Evidence from 10 existing randomized controlled trials shows that retrograde intramedullary nails to repair the distal femoral shaft extraarticular fractures are superior to antegrade intramedullary nails in terms of hip function recovery and fracture healing.Therefore,retrograde intramedullary nails have certain advantages in the treatment of the distal femoral fractures.