Li A-Bing, Zhang Wei-Jiang, Guo Wei-Jun, Wang Xin-Hua, Jin Hai-Ming, Zhao You-Ming
Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Medicine (Baltimore). 2016 Jul;95(29):e4248. doi: 10.1097/MD.0000000000004248.
BACKGROUND AND OBJECTIVE: Intramedullary nailing is commonly used for treating femoral shaft fractures, one of the most common long bone fractures in adults. The reamed intramedullary nail is considered the standard implant for femoral fractures. This meta-analysis was performed to verify the superiority of reamed intramedullary nailing over unreamed intramedullary nailing in fractures of the femoral shaft in adults. Subgroup analysis of implant failure and secondary procedure was also performed. METHODS: Electronic literature databases were used to identify relevant publications and included MEDLINE (Ovid interface), EMBASE (Ovid interface), and the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley Online Library). The versions available on January 30, 2016, were utilized. Only human studies, which were designed as randomized controlled clinical trials, were included. Two authors independently evaluated the quality of original research publications and extracted data from the studies that met the criteria. RESULTS: Around 8 randomized controlled trials involving 1078 patients were included. Reamed intramedullary nailing was associated with shorter time to consolidation of the fracture (SMD = -0.62, 95% CI = -0.89 to -0.35, P < 0.00001), lower secondary procedure rate (OR = 0.25, 95% CI 0.10-0.62, P = 0.003), lower nonunion rate (OR = 0.14, 95% CI = 0.05-0.40, P < 0.01), and lower delayed-union rate (OR = 0.19, 95% CI = 0.07-0.49, P < 0.01) compared to unreamed intramedullary nailing. The 2 groups showed no significant differences in risk of implant failure (OR = 0.50, 95% CI 0.14-1.74, P = 0.27), mortality risk (OR = 0.94, 95% CI 0.19-4.68, P = 0.94), risk of acute respiratory distress syndrome (ARDS; OR = 1.55, 95% CI 0.36-6.57, P = 0.55), or blood loss (SMD = 0.57, 95% CI = -0.22 to 1.36, P = 0.15). CONCLUSION: Reamed intramedullary nailing is correlated with shorter time to union and lower rates of delayed-union, nonunion, and reoperation. Reamed intramedullary nailing did not increase blood loss or the rates of ARDS, implant failure, and mortality compared to unreamed intramedullary nailing. Therefore, the treatment of femoral fractures using reamed intramedullary nailing is recommended.
背景与目的：髓内钉固定术常用于治疗股骨干骨折，这是成人最常见的长骨骨折之一。扩髓髓内钉被认为是股骨干骨折的标准植入物。本荟萃分析旨在验证扩髓髓内钉固定术相对于非扩髓髓内钉固定术治疗成人股骨干骨折的优越性。还对植入物失败和二次手术进行了亚组分析。 方法：使用电子文献数据库识别相关出版物，包括MEDLINE（Ovid界面）、EMBASE（Ovid界面）和Cochrane对照试验中央注册库（CENTRAL；Wiley在线图书馆）。使用2016年1月30日可用的版本。仅纳入设计为随机对照临床试验的人体研究。两位作者独立评估原始研究出版物的质量，并从符合标准的研究中提取数据。 结果：纳入了约8项涉及1078例患者的随机对照试验。与非扩髓髓内钉固定术相比，扩髓髓内钉固定术骨折愈合时间更短（标准化均数差[SMD]= -0.62，95%可信区间[CI]= -0.89至-0.35，P<0.00001），二次手术率更低（比值比[OR]=0.25，95%CI 0.10 - 0.62，P = 0.003），骨不连率更低（OR = 0.14，95%CI = 0.05 - 0.40，P<0.01），延迟愈合率更低（OR = 0.19，95%CI = 0.07 - 0.49，P<0.01）。两组在植入物失败风险（OR = 0.50，95%CI 0.14 - 1.74，P = 0.27）、死亡风险（OR = 0.94，95%CI 0.19 - 4.68，P = 0.94）、急性呼吸窘迫综合征（ARDS）风险（OR = 1.55，95%CI 0.36 - 6.57，P = 0.55）或失血量（SMD = 0.57，95%CI = -0.22至1.36，P = 0.15）方面无显著差异。 结论：扩髓髓内钉固定术与更短的愈合时间以及更低的延迟愈合、骨不连和再次手术率相关。与非扩髓髓内钉固定术相比，扩髓髓内钉固定术不会增加失血量、ARDS发生率、植入物失败率和死亡率。因此，推荐使用扩髓髓内钉固定术治疗股骨干骨折。
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