Guo Yong Cheng, Feng Guo Ming, Xing Guang Wei, Yin Jin Neng, Xia Bing, Dong Yan Zhao, Niu Xue Qiang, He Qianyi, Hu Pengfei
aDepartment of Orthopedics, the Third Affiliated Hospital of Zhengzhou University bDepartment of Internal Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou,China.
J Pediatr Orthop B. 2016 Sep;25(5):466-70. doi: 10.1097/BPB.0000000000000336.
To compare the difference in efficacy following flexible intramedullary nailing (FIN) and external fixation (EF) for pediatric femoral shaft fractures. A systematic search was performed on PubMed, Embase, Medline, and Cochrane library for relevant studies. We included controlled trials comparing complications between FIN and EF for pediatric femoral shaft fractures published before 25 November 2014. Modified Jadad scores were utilized to assess the methodological quality of the studies included. The meta-analysis was carried out using Stata 12.0 software. Six studies involving 237 patients were included. On comparison of EF, a low incidence of overall complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46; P<0.001] and pin-tract infection (RR=0.286, 95% CI: 0.13-0.61; P=0.001), but a high risk of soft tissue irritation (RR=1.86, 95% CI: 1.35-2.56; P<0.001) were found in patients treated with the FIN approach. No significant differences in other complications were found. On the basis of current evidence, the use of FIN leads to fewer complications than EF and may be considered as the first-line approach in the treatment of femoral shaft fractures.
比较弹性髓内钉固定（FIN）和外固定（EF）治疗小儿股骨干骨折后的疗效差异。对PubMed、Embase、Medline和Cochrane图书馆进行了系统检索以查找相关研究。我们纳入了2014年11月25日前发表的比较FIN和EF治疗小儿股骨干骨折并发症的对照试验。采用改良Jadad评分评估纳入研究的方法学质量。使用Stata 12.0软件进行荟萃分析。纳入了6项涉及237例患者的研究。与EF相比，采用FIN治疗的患者总体并发症发生率较低[相对危险度（RR）=0.30，95%置信区间（CI）：0.19 - 0.46；P<0.001]，针道感染发生率较低（RR=0.286，95%CI：0.13 - 0.61；P=0.001），但软组织激惹风险较高（RR=1.86，95%CI：1.35 - 2.56；P<0.001）。在其他并发症方面未发现显著差异。根据现有证据，FIN治疗导致的并发症比EF少，可被视为股骨干骨折治疗的一线方法。
