Kramer Erik James, Shearer David, Morshed Saam
Department of Orthopaedic Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
Orthopaedic Trauma Institute, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA.
Int Orthop. 2016 May;40(5):875-83. doi: 10.1007/s00264-015-3081-3. Epub 2016 Jan 7.
The use of traction for treatment of femoral shaft fractures remains common in low- and middle-income countries (LMICs). The objective of this study is to systematically review the literature on outcomes of traction as definitive treatment for adult femoral shaft fractures in LMICs.
Using the recommended PRISMA methods for systematic reviews, MEDLINE, EMBASE, LILACS, and AJOL were searched for relevant publications. Results were limited to studies occurring in LMICs as defined by the World Bank. Data on time spent in traction (TT), length of stay (LOS), time to partial weight bearing (PWB), complication incidences, and a total complication incidence were recorded.
Of the 693 initial results, nine were eligible for analysis giving a total of 455 unique patients with a mean age of 32.9 years (range: 0 to 96). The average time spent in traction was 52.8 days (range: 19.8 to 122.5), the average length of stay was 55.4 days (range: 45 to 140), and the average time to partial weight bearing was 52.2 days (range: 42 to 60 days). There were a total of 91 malunions, 25 un-united fractures, 60 infections, 45 other complications, giving a total of 221 complications in 455 patients.
The use of traction in treating femoral shaft fractures is associated with a high incidence of complications and prolonged course of treatment. Although operative stabilization may be a better alternative, comparative studies are needed to assess whether this can be achieved in a safe and cost-effective manner for widespread application in LMICs.
在低收入和中等收入国家（LMICs），使用牵引治疗股骨干骨折仍然很常见。本研究的目的是系统回顾关于牵引作为LMICs中成人股骨干骨折确定性治疗方法的疗效的文献。
使用推荐的PRISMA系统评价方法，检索MEDLINE、EMBASE、LILACS和AJOL以获取相关出版物。结果仅限于世界银行定义的LMICs中进行的研究。记录牵引时间（TT）、住院时间（LOS）、部分负重时间（PWB）以及并发症发生率和总并发症发生率的数据。
在693条初始结果中，9条符合分析条件，共有455例独特患者，平均年龄32.9岁（范围：0至96岁）。平均牵引时间为52.8天（范围：19.8至122.5天），平均住院时间为55.4天（范围：45至140天），平均部分负重时间为52.2天（范围：42至60天）。共有91例畸形愈合、25例骨折不愈合、60例感染、45例其他并发症，455例患者中共有221例并发症。
使用牵引治疗股骨干骨折与高并发症发生率和延长的治疗过程相关。尽管手术稳定可能是更好的选择，但需要进行比较研究以评估是否可以以安全且经济有效的方式实现这一点，以便在LMICs中广泛应用。
