髓内钉与钢板内固定治疗胫骨远端关节外骨折的比较研究  

A systematic comparative study of intramedullary nail and plate fixation in treatment of extra-articular distal tibial fractures

作　　者：李乾明[1] 周家钤[1] 赵宏谋[1] 夏江[1] 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科,上海市200065

出　　处：《中国骨与关节损伤杂志》2012年第4期317-320,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的通过对已发表文献进行汇总分析,根据现有数据资料总结髓内钉与钢板内固定治疗胫骨远端关节外骨折预后的比较。方法通过系统检索1975年1月～2011年5月发表的关于钢板或髓内钉治疗胫骨远端关节外骨折的英文文献。2位作者全文阅读并决定是否符合纳入标准或排除标准,收集相关结果和数据,通过循证医学分析方法,加权汇总分析两种治疗方案的功能预后和并发症。结果有22篇文献纳入研究,包括880例手术患者。髓内钉组的平均手术时间长于钢板组,但差异无统计学意义。髓内钉组的平均愈合时间显著短于钢板组。髓内钉组的感染率低于钢板组,但差异无统计学意义。髓内钉组的畸形愈合率显著高于钢板组。髓内钉组骨折的延迟愈合率和不愈合率与钢板组无统计学差异。髓内钉组的二次处理率(13.6%)高于钢板组(8.9%),但差异无统计学意义。结论根据此项研究结果,髓内钉内固定治疗胫骨远端关节外骨折可以更快愈合,使患者更早进行功能锻炼,但畸形愈合的概率高于钢板组,因此,具体的术式选择还应该根据患者的具体情况和医生的习惯决定。Objective To review and compare the outcomes of the intramedullary nail and plate fixation for the treatment of extra-articular distal tibial fracture by analyzing the published studies.Methods A comprehensive search of all relevant articles from January 1975 to May 2011 was conducted.Two reviewers evaluated each study to determine whether it was eligible for inclusion and collected the data of interest.Meta-analytic pooling of group results across studies was performed for the two treatment methods.Results The systematic review identified 22 primary studies with 880 fractures.The average operative time in the intramedullary nail group was longer than the plate group,but the difference was not significant.No significant difference was found in the infection,delay union and nonunion rate.The reoperation rate was higher in the intramedullary nail group（13.6%） compared with the plate osteosynthesis group（8.9%）,but the difference was not significant.The average healing time in the intramedullary nail group was significantly shorter than the plate group,but the malunion rate was significantly higher in the plate group.Conclusion Based on the results of this systematic review,for extra-articular distal tibial fractures,shorter healing time could be achieved by using the intramedullary nail,and the early functional exercise is easier to be applied,thus the choice of the operation method depends on the condition of the patient and the doctor＇s preference.

关 键 词：胫骨远端骨折 手术 髓内钉 钢板 

分 类 号：R683.42[医药卫生—骨科学]