可膨胀髓内钉与交锁髓内钉修复胫骨骨折的Mefa分析  

A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of tibia fracture

作　　者：王文达[1] 金祺[1] 阮文枫 平安松[1] 

机构地区：[1]武汉大学中南医院骨科,湖北省武汉市430071

出　　处：《中国组织工程研究》2015年第53期8670-8676,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前已有大量研究证实可膨胀髓内钉和交锁髓内钉在修复四肢骨折方面均有确切疗效。但是对于胫骨骨折的治疗,两种内固定方式的优劣尚无定论。目的:系统评价可膨胀髓内钉与交锁髓内钉置入内固定修复胫骨骨折的安全性及有效性。方法:计算机检索Pub Med、Embase、The Cochrane Library(2015年第1期)、CBM、CNKI、VIP、WanFang Data,检索词包括:tibia,fracture,tibia fracture,tibia fractures,expandable intramedullary nail,expandable nail,intramedullary nail,interlocking intramedullary nail,膨胀,髓内钉,胫骨骨折等。检索时限均为从建库至2015-01-01。查找比较可膨胀髓内钉与交锁髓内钉修复胫骨骨折的随机对照试验。采用Rev Man 5.2软件进行Meta分析。结果与结论:最终纳入10个研究,共574例患者。Meta分析结果显示,与交锁髓内钉相比,可膨胀髓内钉组手术时间更短[MD=-23.42,95%CI(-26.94,-19.90),P<0.000 01]、术中出血更少[MD=-47.64,95%CI(-52.21,-43.09),P<0.000 01]、透视次数更少[MD=-1.40,95%CI(-1.49,-1.30),P<0.000 01]、骨折愈合时间更短[MD=-30.84,95%CI(-35.27,-26.41),P<0.000 01]、并发症发生率更少[OR=0.20,95%CI(0.10,0.40),P<0.000 01]。但两组患者治疗后Johner-Wruh评分差异无显著性意义。提示可膨胀髓内钉应用于胫骨骨折的修复效果较交锁髓内钉更具优势,可以说可膨胀髓内钉是对交锁髓内钉的一种改进,但仍需要大样本高质量的随机对照试验进一步证实该结论。BACKGROUND： At present, a large number of studies have proved that the expandable intramedullary nail and interlocking intramedullary nail are effective in treatment of limb fractures. However, for the treatment of tibial fractures, the advantages and disadvantages of the two kinds of fixation methods are still inconclusive. OBJECTIVE： To systematically review the effectiveness and safety of expandable intramedullary nail and interlocking intramedullary nail for treatment of tibia fracture. METHODS： We searched PubMed, Embase, The Cochrane Library （Issue 1,2015）, CBM, CNKI, VIP and WanFang Data for articles Concerning randomized Controlled trials on expandable intramedullary nail versus interlocking intramedullary nail published from inception to January 1,2015. The key words were ＂tibia, fracture, tibia fracture, tibia fractures, expandable intramedullary nail, expandable nail, intramedullary nail, interlocking intramedullary nail＂. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION： Ten randomized controlled trials involving 574 patients were included. Theresults of meta-analysis showed that, compared with interlocking intramedullary nail, expandable intramedullary nail was shorter in operation time [MD=-23.42, 95%CI（-26.94, -19.90）, P 〈 0.000 01], less in intraoperative hemorrhage [MD=-47.64, 95%CI（-52.21, -43.09）, P 〈 0.000 01], less in fluoroscopy times [MD=-1.40, 95%CI（-1.49, -1.30）, P 〈 0.000 01], shorter in union time [MD=-30.84, 95%CI（-35.27, -26.41）, P 〈 0.000 01], and tess in incidence of complications [OR=0.20, 95%CI（0.10, 0.40）, P 〈 0.000 01]. The Johner-Wruh scores showed on significant difference. These findings suggest that expandable intramedullary nail for tibia fracture has more advantages than interlocking intramedullary nail. That is to say, the expandable intramedutlary nail is an improved nait of interlocking intramedullary nail, but a large＇sample of high quality randomized controlled trials are still needed to conf

关 键 词：胫骨 骨折 骨钉 内固定器 循证医学 随机对照试验 组织工程 

分 类 号：R318[医药卫生—生物医学工程]