Xia Liheng, Zhou Jian, Zhang Yongtao, Mei Gang, Jin Dan
Orthopedics. 2014 Apr;37(4):e332-8. doi: 10.3928/01477447-20140401-52.
Controversy exists regarding the clinical outcomes of reamed vs unreamed intramedullary nailing in the treatment of closed tibial fractures. This study assessed the effects of reamed vs unreamed intramedullary nailing for closed tibial fractures. The authors searched PubMed, EMBASE, BIOSIS, and the Cochrane Controlled Trials Register for randomized and quasi-randomized controlled clinical trials from January 1980 to June 2012 comparing reamed with unreamed intramedullary nailing for closed tibial fracture in adults. Primary outcomes were nonunion, delayed union, malunion, secondary procedure, failure of implants, compartment syndrome, infection, and knee pain. Eight randomized and 1 quasi-randomized clinical trials (1229 fractures) were included. No statistically significant differences were found between reamed and unreamed nailing groups in delayed union (P=.20), malunion (P=.28), infection (P=.36), compartment syndrome (P=.36), and knee pain (P=.93). The unreamed group had a higher rate of fracture nonunion than the reamed group (P=.02). The subgroup analysis of implant failures (broken screws vs broken nails) indicated that reamed nailing significantly reduced the risk of screw breakage (P<.001); however, there was no significant difference between reamed and unreamed intramedullary nailing in nail breakage (P=.94). The subgroup analysis of a secondary procedure showed that the reamed intramedullary nailing resulted in significantly lower risks of implant exchange (P=.01) and dynamization (P=.04); however, there was no significant difference in bone grafting rate (P=.73). Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risks of nonunion, screw failure, implant exchange, and dynamization without increasing operative complications.
关于扩髓与非扩髓髓内钉治疗闭合性胫骨骨折的临床疗效存在争议。本研究评估了扩髓与非扩髓髓内钉治疗闭合性胫骨骨折的效果。作者检索了PubMed、EMBASE、BIOSIS和Cochrane对照试验注册库，以查找1980年1月至2012年6月期间比较扩髓与非扩髓髓内钉治疗成人闭合性胫骨骨折的随机和半随机对照临床试验。主要结局包括骨不连、延迟愈合、畸形愈合、二次手术、植入物失败、骨筋膜室综合征、感染和膝关节疼痛。纳入了8项随机和1项半随机临床试验（共1229例骨折）。扩髓组与非扩髓组在延迟愈合（P = 0.20）、畸形愈合（P = 0.28）、感染（P = 0.36）、骨筋膜室综合征（P = 0.36）和膝关节疼痛（P = 0.93）方面未发现统计学显著差异。非扩髓组的骨折不愈合率高于扩髓组（P = 0.02）。植入物失败（螺钉断裂与髓内钉断裂）的亚组分析表明，扩髓髓内钉显著降低了螺钉断裂的风险（P < 0.001）；然而，扩髓与非扩髓髓内钉在髓内钉断裂方面无显著差异（P = 0.94）。二次手术的亚组分析表明，扩髓髓内钉导致植入物更换（P = 0.01）和动力化（P = 0.04）的风险显著降低；然而，植骨率无显著差异（P = 0.73）。比较扩髓与非扩髓髓内钉治疗闭合性胫骨骨折的证据表明，扩髓髓内钉可能显著降低骨不连、螺钉失败、植入物更换和动力化的风险，且不增加手术并发症。
