弹性髓内钉与人字形石膏固定术治疗儿童股骨干骨折的有效性与安全性的Meta分析  

Evaluation on the effcacy and safety of titanium elastic nails compared to spica cast in the treatment of pediatric femoral shaft fracture in children based on evidence-based medicine

作　　者：廖国平 尹新生 尹莺桦 周光华 尹书东 陈小华 Liao Guoping;Yin Xinsheng;Yin Yinghua;Zhou Guanghua;Yin Shudong;Chen Xiaohua(Department of Pharmacy,Changning Hospital of Traditional Chinese Medicine,Hunan 421500,China;不详)

机构地区：[1]湖南省常宁市中医医院药剂科,421500 [2]湖南省常宁市中医医院骨伤科,421500 [3]海南医学院中医学院

出　　处：《山西医药杂志》2020年第22期3043-3046,共4页Shanxi Medical Journal

基　　金：湖南省中医药科研计划项目(201973)。

摘　　要：目的研究比较弹性髓内钉与人字形石膏固定术治疗儿童股骨干骨折的有效性与安全性。方法计算机检索PubMed、EMBASE、The Cochrane Library和中国知网,收集弹性髓内钉与人字形石膏固定术2种术式比较治疗儿童股骨干骨折的临床试验。从纳入的研究提取资料并对其进行质量评价,再用RevMan 5.3软件进行Meta分析。结果最终纳入10项临床试验,共916例患者。弹性髓内钉组的骨折愈合时间和住院时长均显著短于人字形石膏固定术组[SMD骨折愈合时间=-0.77,95%CI(-1.10,-0.44),P<0.01;SMD住院时长=-3.23,95%CI(-4.96,-1.50),P=0.0003];弹性髓内钉组患者的独立行走率和满意度均与人字形石膏固定术组相当,差异无统计学意义[RR独立行走率=1.65,95%CI(0.94,2.88),P=0.08;RR满意度=1.61,95%CI(0.88,2.88),P=0.12];弹性髓内钉组患者的矢状位成角和冠状面成角均显著小于人字形石膏固定术组(SMD矢状位成角=-0.48,95%CI(-0.70,-0.26),P<0.01;SMD冠状面成角=-0.66,95%CI(-1.00,-0.31),P=0.0002);弹性髓内钉组患者的畸形愈合发生率和对线不良发生率显著低于人字形石膏固定术组[RR畸形愈合=0.38,95%CI(0.23,0.63),P=0.0001;RR对线不良=0.39,95%CI(0.27,0.56),P<0.01]。结论与人字形石膏固定术相比,弹性髓内钉可有效缩短股骨干骨折儿童的骨折愈合时间和住院时长,并具有较低的矢状位成角、冠状面成角、畸形愈合发生率和对线不良发生率。Objective To evaluate the effcacy and safety of titanium elastic nails(TEN)compared to spica cast in the treatment of pediatric femoral shaft fracture based on evidence-based pharmacy.Methods Clinical trials regarding the effcacy and safety of TEN compared to spica cast in the treatment of pediatric femoral shaft fracture were searched in the databases PubMed,EMBASE,The Cochrane Library and CNKI.We extracted data and assessed the quality of the literature and adopted RevMan 5.3 to conduct meta-analysis on each effective index.Results A total of 916 patients from 10 clinical trials were finally included.The meta-analysis showed that the duration to union standardized mean difference[SMD=-0.77,95%CI(-1.10,-0.44),P<0.01]and length of hospital stay[SMD=-3.23,95%CI(-4.96,-1.50),P=0.0003]in TNE group were significantly shorter than those in spica cast group.The rate of walking independently[Risk Ratio(RR)=1.65,95%CI(0.94,2.88),P=0.08]and parent satisfaction[RR=1.61,95%CI(0.88,2.88),P=0.12]have no differences between the two groups.The sagittal angulations[SMD=-0.48,95%CI(-0.70,-0.26),P<0.01]and coronal angulations(SMD=-0.66,95%CI[-01.00,-0.31],P=0.0002)in TNE group were significantly less than those in spica cast group.The rate of malunion(RR=0.38,95%CI[0.23,0.63],P=0.001)and malalignment(RR=0.39,95%CI[0.27,0.56],P<0.01)in TNE group were significantly lower than those in spica cast group.Conclusion Compared to spica cast,TEN fxation could shorten the duration to union and the length of hospital stay,decrease the sagittal angulations,coronal angulations,malunion and malalignment in pediatric femoral shaft fractures.

关 键 词：弹性髓内钉 人字形石膏固定术 儿童股骨干骨折 循证医学 

分 类 号：R726.8[医药卫生—儿科]