Somford Matthijs P, van den Bekerom Michel P J, Kloen Peter
Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 15, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands,
Strategies Trauma Limb Reconstr. 2013 Aug;8(2):77-88. doi: 10.1007/s11751-013-0168-5. Epub 2013 Jul 27.
The objective of this article is to systematically review the currently available literature to formulate evidence-based guidelines for the treatment of femoral shaft nonunions for clinical practice and to establish recommendations for future research. Articles from PubMed/MEDLINE, Cochrane Clinical Trial Register, and EMBASE, that presented data concerning treatment of nonunions of femoral shaft fractures in adult humans, were included for data extraction and analysis. The search was restricted to articles from January 1970 to March 2011 written in the English, German, or Dutch languages. Articles containing data that were thought to have been presented previously were used once. Reports on nonunion after periprosthetic fractures, review articles, expert opinions, abstracts from scientific meetings, and case reports on 5 or fewer patients were excluded. The data that were extracted from the relevant articles included: type of nonunion, type of initial and secondary treatments, follow-up, union rate, and general complications. Most studies had different inclusion criteria and outcome measures, thus prohibiting a proper meta-analysis. Therefore, only the union rate and number of complications were compared between the different treatments. Methodological quality was assessed by assigning levels of evidence as previously defined by the Centre for Evidence-Based Medicine. This systematic review provides evidence in favour of plating if a nail is the first treatment; after failed plate fixation, nailing has a 96 % union rate. After failed nailing, augmentative plating results in a 96 % union rate compared to 73 % in the exchange nailing group.
本文的目的是系统回顾当前可得的文献，以制定基于证据的股骨干骨不连治疗指南用于临床实践，并为未来研究提出建议。纳入了来自PubMed/MEDLINE、Cochrane临床试验注册库和EMBASE的文章，这些文章提供了有关成年人类股骨干骨折骨不连治疗的数据，用于数据提取和分析。检索限于1970年1月至2011年3月以英文、德文或荷兰文撰写的文章。包含被认为先前已发表数据的文章仅使用一次。排除有关假体周围骨折后骨不连的报告、综述文章、专家意见、科学会议摘要以及5例或更少患者的病例报告。从相关文章中提取的数据包括：骨不连类型、初始和二次治疗类型、随访、愈合率和一般并发症。大多数研究有不同的纳入标准和结局指标，因此无法进行适当的荟萃分析。因此，仅比较了不同治疗方法之间的愈合率和并发症数量。采用循证医学中心先前定义的证据水平来评估方法学质量。本系统评价提供的证据表明，如果首次治疗采用髓内钉，则钢板固定更有利；钢板固定失败后，髓内钉固定的愈合率为96%。髓内钉固定失败后，辅助钢板固定的愈合率为96%，而交锁髓内钉组为73%。
