Department of Trauma and Orthopaedics, Hatzikosta General Hospital, Ioannina, Greece.
Injury. 2011 Dec;42(12):1408-15. doi: 10.1016/j.injury.2011.10.015. Epub 2011 Oct 22.
The aim of the present study was to comparatively analyse certain outcome measures of open tibial fractures, stratified per grade of open injury and method of treatment. For this purpose, a systematic review of the English literature from 1990 until 2010 was undertaken, comprising 32 eligible articles reporting on 3060 open tibial fractures. Outcome measures included rates of union progress (early union, delayed union, late union and non-union rates) and certain complication rates (deep infection, compartment syndrome and amputation rates). Statistical heterogeneity across component studies was detected with the use of Cochran chi-square and I(2) tests. In the absence of significant statistical heterogeneity a pooled estimate of effect size for each outcome/complication of interest was produced. All component studies were assigned on average a moderate quality score. Reamed tibial nails (RTNs) were associated with significantly higher odds of early union compared with unreamed tibial nails (UTNs) in IIIB open fractures (odds ratio: 12, 95% CI: 2.4-61). Comparing RTN and UTN modes of treatment, no significant differences were documented per grade of open fractures with respect to both delayed and late union rates. Surprisingly, nonunion rates in IIIB open fractures treated with either RTNs or UTNs were lower than IIIA or II open fractures, although the differences were not statistically significant. Significantly increased deep infection rates of IIIB open fractures compared with all other grades were documented for both modes of treatment (RTN, UTN). However, lower deep infection rates for IIIA open fractures treated with RTNs were recorded compared with grades I and II. Interestingly, grade II open tibial fractures, treated with UTN, presented significantly greater odds for developing compartment syndrome than when treated with RTNs. Our cumulative analysis, providing for each grade of open injury and each particular method of treatment a summarised estimate of effect size for the most important outcome measures of open tibial fractures, constitutes a useful tool of the practicing surgeon for optimal decision making when operative treatment of such fractures is contemplated.
本研究的目的是比较分析开放性胫骨骨折的某些结果测量指标，按开放性损伤程度和治疗方法进行分层。为此，对 1990 年至 2010 年期间的英文文献进行了系统回顾，共纳入 32 篇符合条件的文章，报道了 3060 例开放性胫骨骨折。结果测量指标包括愈合进展率（早期愈合、延迟愈合、晚期愈合和不愈合率）和某些并发症发生率（深部感染、筋膜间室综合征和截肢率）。使用 Cochran chi-square 和 I(2)检验检测各组成研究之间的统计异质性。如果没有显著的统计学异质性，则会生成每个感兴趣的结果/并发症的合并效应大小估计值。所有组成研究的平均质量评分为中度。在 IIIB 开放性骨折中，与非扩髓胫骨钉（UTN）相比，扩髓胫骨钉（RTN）与早期愈合的几率显著增加（比值比：12，95%置信区间：2.4-61）。比较 RTN 和 UTN 治疗方式，在开放性骨折各程度方面，延迟和晚期愈合率均无显著差异。令人惊讶的是，无论采用 RTN 还是 UTN，III B 开放性骨折的不愈合率均低于 IIIA 或 II 开放性骨折，尽管差异无统计学意义。与所有其他等级相比，III B 开放性骨折的深部感染率明显升高，两种治疗方式均如此（RTN、UTN）。然而，与 I 级和 II 级相比，采用 RTN 治疗的 IIIA 开放性骨折的深部感染率较低。有趣的是，与采用 RTN 治疗相比，采用 UTN 治疗的 II 级开放性胫骨骨折发生筋膜间室综合征的几率显著增加。我们的累积分析为每种开放性损伤程度和每种特定治疗方法提供了开放性胫骨骨折最重要结果测量指标的合并效应大小的总结估计值，为考虑手术治疗此类骨折的临床医生提供了一个有用的决策工具。
