Bhandari M, Guyatt G H, Swiontkowski M F, Schemitsch E H
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
J Bone Joint Surg Br. 2001 Jan;83(1):62-8. doi: 10.1302/0301-620x.83b1.10986.
We have systematically reviewed the effect of alternative methods of stabilisation of open tibial fractures on the rates of reoperation, and the secondary outcomes of nonunion, deep and superficial infection, failure of the implant and malunion by the analysis of 799 citations on the subject, identified from computerised databases. Although 68 proved to be potentially eligible, only eight met all criteria for inclusion. Three investigators independently graded the quality of each study and extracted the relevant data. One study (n = 56 patients) suggested that the use of external fixators significantly decreased the requirement for reoperation when compared with fixation with plates. The use of unreamed nails, compared with external fixators (five studies, n = 396 patients), reduced the risk of reoperation, malunion and superficial infection. Comparison of reamed with unreamed nails showed a reduced risk of reoperation (two studies, n = 132) with the reamed technique. An indirect comparison between reamed nails and external fixators also showed a reduced risk of reoperation (two studies) when using nails. We have identified compelling evidence that unreamed nails reduced the incidence of reoperations, superficial infections and malunions, when compared with external fixators. The relative merits of reamed versus unreamed nails in the treatment of open tibial fractures remain uncertain.
我们通过分析从计算机数据库中识别出的799篇关于该主题的文献，系统回顾了开放性胫骨骨折不同稳定方法对再次手术率的影响，以及骨不连、深部和浅部感染、植入物失效和畸形愈合等次要结局。尽管68篇文献被证明可能符合条件，但只有8篇符合所有纳入标准。三位研究者独立对每项研究的质量进行评分并提取相关数据。一项研究（n = 56例患者）表明，与钢板固定相比，使用外固定架可显著降低再次手术的需求。与外固定架相比（五项研究，n = 396例患者），使用非扩髓髓内钉可降低再次手术、畸形愈合和浅部感染的风险。扩髓髓内钉与非扩髓髓内钉的比较显示，扩髓技术可降低再次手术风险（两项研究，n = 132）。扩髓髓内钉与外固定架之间的间接比较也显示，使用髓内钉时再次手术风险降低（两项研究）。我们已确定有力证据表明，与外固定架相比，非扩髓髓内钉可降低再次手术、浅部感染和畸形愈合的发生率。扩髓髓内钉与非扩髓髓内钉在治疗开放性胫骨骨折方面的相对优缺点仍不确定。
