Zhao Liang, Wang Baojun, Bai Xiaodong, Liu Zhenyu, Gao Hua, Li Yadong
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China.
World J Surg. 2017 Mar;41(3):722-733. doi: 10.1007/s00268-016-3753-1.
The aim of this study was to compare the radiographic and functional outcomes of operative intervention in patients with both-bone forearm fractures treated by open reduction and internal fixation (ORIF) with plates or intramedullary (IM) nailing.
Studies published in PubMed, EMBASE, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and CNKI (China National Knowledge Infrastructure, China) were systematically searched. The main outcomes included time to union, union rate, operation time, magnitude and location of radial bow, loss of forearm rotation, and complication rates. Results were expressed with weighted mean difference or risk ratio with 95 % confidence intervals. Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among studies.
A total of 13 studies met the inclusion criteria and were included in this meta-analysis. Compared with ORIF, IM nailing significantly reduced the operation time and complication rate. However, no significant differences were observed between the two surgical techniques in several outcomes, including time to union, union rate, radial bow magnitude, and loss of forearm rotation. Except in complications, these findings were consistent across the subgroup analysis of children and adult patients.
IM nailing is associated with shorter operation time and lower complication rate compared with ORIF. It is an effective and safe treatment option for children and adults with both forearm fractures. However, considering the limitations in this study, large-scale, high-quality randomized controlled trials are needed to indentify these findings.
本研究旨在比较采用钢板切开复位内固定术（ORIF）或髓内钉固定术治疗双侧前臂骨折患者的影像学和功能结局。
系统检索了发表于PubMed、EMBASE、科学网、中国生物医学文献服务系统（SinoMed）和中国知网（CNKI）的研究。主要结局包括骨折愈合时间、愈合率、手术时间、桡骨弓的大小和位置、前臂旋转功能丧失以及并发症发生率。结果以加权平均差或风险比及95%置信区间表示。根据研究间的异质性，使用固定效应模型或随机效应模型计算合并估计值。
共有13项研究符合纳入标准并纳入本荟萃分析。与ORIF相比，髓内钉固定术显著缩短了手术时间并降低了并发症发生率。然而，在骨折愈合时间、愈合率、桡骨弓大小和前臂旋转功能丧失等几个结局方面，两种手术技术之间未观察到显著差异。除并发症外，这些结果在儿童和成人患者的亚组分析中是一致的。
与ORIF相比，髓内钉固定术手术时间更短，并发症发生率更低。对于双侧前臂骨折的儿童和成人，它是一种有效且安全的治疗选择。然而，考虑到本研究的局限性，需要大规模、高质量的随机对照试验来验证这些结果。
