阻挡钉技术应用于下肢长骨干骨折临床疗效及并发症的meta分析

Clinical efficacy and complications of blocking screw fixation in the treatment of lower limb long bone fracture:a meta-analysis

目的系统评价髓内钉结合阻挡钉技术治疗股骨干或胫骨干骨折的临床疗效及并发症。方法计算机检索PubMed、Embase、OVID、Cochrane library、中国生物医学文献数据库(CBM)、万方数据库、中国期刊全文数据库(CNKI)及维普数据库,收集建库至2021年6月期间公开发表的有关髓内钉联合阻挡钉技术治疗股骨干或胫骨干骨折临床疗效的中英文文献,严格筛选文献、质量评价及提取相关资料,采用Revman5.3及Stata15.0软件进行meta分析。结果最终纳入18篇文献,共1109例患者。meta分析结果显示,与非阻挡钉组相比较,阻挡钉组尽管手术时间长[MD=10.94,95%CI(3.58,18.30),P=0.004]、术中X线透视次数多[MD=57.62,95%CI(25.82,89.42),P=0.0002],但其术后治疗有效率更高[OR=5.60,95%CI(2.10,14.93),P=0.0006]、术后踝关节功能更好[OR=5.32,95%CI(1.86,15.23),P=0.002]、骨折愈合率更高[OR=4.70,95%CI(1.33,16.63),P=0.02]、骨折愈合时间更短[MD=-3.24,95%CI(-4.58,-1.90),P<0.00001]、术中出血更少[MD=-47.71,95%CI(-86.03,-9.40),P=0.01]、住院时间更短[MD=-2.14,95%CI(-3.25,-1.03),P=0.0002],并发症更少[OR=0.32,95%CI(0.13,0.80),P=0.01],两组膝关节活动度无差异[MD=10.04,95%CI(-1.51,21.59),P=0.09]。结论当前证据表明,髓内钉联合阻挡钉技术治疗下肢长骨干骨折具有临床疗效好、骨折愈合率高、骨折愈合时间短、关节功能好、并发症少等优点,值得临床推荐。

Objective To explore the clinical efficacy and complications arising from the use of an intramedullary nail combined with a blocking screw technique in the treatment of femoral or tibial shaft fractures.Methods The PubMed,Embase,OVID,Cochrane library,CBM,Wanfang,CNKI and VIP databases were searched for studies of intramedullary nail combined with blocking screw fixation in the treatment of femoral or tibial shaft fractures published up to June 2021.The methodological quality of the trials was assessed,relevant data were extracted,and RevMan 5.3 and Stata 15.0 software were used to perform a meta-analysis of parameters related to the outcomes.Results Eighteen articles were included,involving 1109 patients.Meta-analysis results showed that,compared with the non-blocking screw group,the blocking screw group had longer operation time[MD=10.94,95%CI(3.58,18.30),P=0.004]and more intraoperative fluoroscopy times[MD=57.62,95%CI(25.82,89.42),P=0.0002].However,the postoperative treatment rate was higher[OR=5.60,95%CI(2.10,14.93),P=0.0006],postoperative ankle joint function was better[OR=5.32,95%CI(1.86,15.23),P=0.002],the fracture healing rate was higher[OR=4.70,95%CI(1.33,16.63),P=0.02],the fracture healing time was shorter[MD=-3.24,95%CI(-4.58,-1.90),P<0.00001],intraoperative bleeding was less[MD=-47.71,95%CI(-86.03,-9.40),P=0.01],hospitalization time was shorter[MD=-2.14,95%CI(-3.25,-1.03),P=0.0002],and complications were fewer[OR=0.32,95%CI(0.13,0.80),P=0.01]in the blocking screw group.There was no significant difference in the range of motion of the knee joint between the two groups[MD=10.04,95%CI(-1.51,21.59),P=0.09].Conclusion These data show that intramedullary nailing combined with the blocking screw technique in the treatment of lower limb long bone fracture has several advantages including good clinical efficacy,high fracture healing rate,short fracture healing time,good joint function,and fewer complications,and it is therefore worthy of clinical recommendation.