顺行锁定髓内钉和动力加压钢板治疗肱骨干骨折的系统评价  

Antegrade locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures: a meta-analysis

作　　者：薛镜[1] 黄富国[1] 项舟[1] 岑石强[1] 钟刚[1] 

机构地区：[1]四川大学华西医院骨科,四川成都610041

出　　处：《中国矫形外科杂志》2017年第22期2055-2060,共6页Orthopedic Journal of China

摘　　要：[目的]对比顺行锁定髓内钉和动力加压钢板治疗肱骨干骨折的临床结果,并为以后此类骨折的治疗提供更可信的证据。[方法]计算机检索Cochrane library、Medline、Embase、CNKI等数据库网站,检索2016年12月以前有关顺行锁定髓内钉和动力加压钢板治疗肱骨干骨折的文献,筛选文献后采用Revman 5.0软件进行分析,获得两种方法治疗肱骨干骨折的临床结果。[结果]最初搜索文献472篇,经过筛选后最终有8篇纳入研究,共计完成随访患者373例,其中顺行髓内钉治疗者187例,动力加压钢板治疗者186例。Meta分析表明,顺行锁定髓内钉组患者术后感染率明显低于动力加压钢板组[OR=0.34,95%CI(0.12,0.98),P=0.05],但前者肩部撞击征与再次手术率明显高于后者[OR=7.81,95%CI(2.51,24.33),P<0.001;OR=2.61,95%CI(1.19,5.72),P=0.02],术后桡神经损伤与骨折不愈合率,两者之间差异无统计学意义。[结论]与顺行锁定髓内钉相比,动力加压钢板治疗肱骨干骨折可以降低肩部撞击征与再次手术发生率,但却增加了术后感染的发生率;术后桡神经损伤及骨折不愈合方面,两者差异无统计学意义。[Objective] To compare clinical outcomes of antegrade locked intramedullary nailing versus dynamic compres- sion plating for the primary surgical fixation of humeral shaft fraetures. [Methods] An electronic＇ search was conducted using the databases including the Cochrane library, Medline, Embase and CNKI. A literature search was performed for all the stud- ies published in the all languages from the earliest records to December 2016 regarding to antegrade locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures. After meticulous data extraction, a recta-analysis was performed were performed using Review Manager Software 5.0. [Results] At the initial search 472 articles were sought out. Only 8 articles met to the criteria ＇after a review were included into this study. There were 373 patients including 187 with the nail and 186 with the plate for treatment of humeral shaft fractures. The antegrade locked intramedullary nailing bad significantly lower postoperative infection compared to dynamic compression plating IOR=0.34, 95% CI （0.12, 0,98）, P=0,05], however, the for- mer got the increased incidence of shoulder impairment and reoperation over the latter [OR=7.81, 95% CI （2.51, 24.33 ） , P= 0.0004; OR=2.61, 95% CI （1.19, 5.72） , P=0,02]. There were no significant differences in incidences of nonunion, radial nerve palsy between the two techniques. [Conclusion] On the basis of current evidence, both antegrade locked intramedullary nailing and dynamic compression plating have similar risk of nonunion and radial nerve palsy. However the nailing increases the chance of shoulder impairment and reoperation, conversely decrease postoperative infection compared with the plating.

关 键 词：肱骨骨折 髓内钉 钢板 系统评价 

分 类 号：R687.3[医药卫生—骨科学]