Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Injury. 2010 Jul;41(7):671-5. doi: 10.1016/j.injury.2010.02.020. Epub 2010 Mar 11.
Nonunion after intramedullary nailing (IMN) in patients with tibial shaft fractures occurs up to 16%. There is no agreement whether reaming prior to IMN insertion would reduce the nonunion rate. We aimed to compare the nonunion rate between reamed and unreamed IMN in patients with tibial shaft fractures. A systematic search was conducted in Pubmed, Embase, and the Cochrane Library. The selected publications were: (1) randomised controlled trials; (2) comparing the nonunion rate; (3) in patients with tibial shaft fractures; (4) treated with either reamed or unreamed IMN. Seven studies that satisfied the criteria were identified. They showed that reamed IMN led to reduction of nonunion rate compared to unreamed IMN in closed tibial shaft fractures (risk difference ranging 7.0-20%, number needed to treat ranging 5-14), while the difference between compared treatments for open tibial shaft fractures was not clinically relevant. The evidence showed a consistent trend of reduced nonunion rate in closed tibial shaft fracture treated with reamed compared to unreamed IMN.
髓内钉（IMN）治疗胫骨骨干骨折后不愈合的发生率高达 16%。目前对于 IMN 插入前扩髓是否会降低不愈合率尚未达成共识。我们旨在比较胫骨骨干骨折患者中扩髓与非扩髓 IMN 的不愈合率。在 Pubmed、Embase 和 Cochrane Library 中进行了系统检索。选择的出版物为：（1）随机对照试验；（2）比较不愈合率；（3）在胫骨骨干骨折患者中；（4）采用扩髓或非扩髓 IMN 治疗。确定了 7 项符合标准的研究。结果表明，与非扩髓 IMN 相比，扩髓 IMN 可降低闭合性胫骨骨干骨折的不愈合率（风险差为 7.0%-20%，需要治疗的数量为 5-14），而开放性胫骨骨干骨折的比较治疗之间的差异无临床意义。证据表明，与非扩髓 IMN 相比，扩髓治疗闭合性胫骨骨干骨折的不愈合率呈降低趋势。
