Xu Wei-Guo
Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2017 May;9(2):159-166. doi: 10.1111/os.12330. Epub 2017 Jun 7.
The objective of this systematic review and meta-analysis was to compare the lengthening and then nailing (LATN) technique to the conventional Ilizarov method for limb lengthening. A systemic search of potential relevant literature was performed in databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and the ISI Web of Knowledge, from their inception to 22 May 2015 using medical subject heading (MeSH) terms "Ilizarov," "bone lengthening," or "intramedullary nail." A total of 89 titles and abstracts were preliminarily reviewed, of which 4 studies eventually satisfied the eligibility criteria, consisting of one randomized controlled trial (RCT), two clinical controlled trials and one retrospective cohort study. A total of 354 limbs were included in the study, among which 183 were lengthened over an intramedullary nail, and 171 limbs were lengthened conventionally. The mean difference (MD) was -50.21 for the external fixation index between the two groups (95% CI, -51.83 to -48.59; P < 0.00001) with high heterogeneity (I = 99%); no significant difference in length was gained (MD = -0.30, 95% CI = -0.72 to 0.12; P = 0.16) with high heterogeneity (I = 80%); and there was high significant difference for the consolidation index (MD = -19.97; 95% CI, -21.59 to -18.35; P < 0.00001) with high heterogeneity (I = 100%). The overall rate of complications was relatively low, and differed significantly between the two groups. Through this meta-analysis, we find that LATN is superior to the conventional method in regards to the external fixation index and the consolidation index, which means that LATN is an effective technique that can decrease the time needed in external fixation.
本系统评价和荟萃分析的目的是比较先延长再髓内钉固定（LATN）技术与传统伊里扎洛夫方法在肢体延长方面的效果。从数据库创建至2015年5月22日，使用医学主题词（MeSH）“伊里扎洛夫”、“骨延长”或“髓内钉”，在包括Cochrane对照试验中央注册库（CENTRAL）、PubMed、EMBASE和ISI科学网在内的数据库中进行了潜在相关文献的系统检索。初步检索了共89篇标题和摘要，其中4项研究最终符合纳入标准，包括1项随机对照试验（RCT）、2项临床对照试验和1项回顾性队列研究。该研究共纳入354条肢体，其中183条通过髓内钉延长，171条采用传统方法延长。两组间外固定指数的平均差值（MD）为-50.21（95%可信区间，-51.83至-48.59；P<0.00001），异质性高（I=99%）；在延长长度方面无显著差异（MD=-0.30，95%可信区间=-0.72至0.12；P=0.16），异质性高（I=80%）；骨愈合指数有高度显著差异（MD=-19.97；95%可信区间，-21.59至-18.35；P<0.00001），异质性高（I=100%）。总体并发症发生率相对较低，且两组间有显著差异。通过该荟萃分析，我们发现LATN在外固定指数和骨愈合指数方面优于传统方法，这意味着LATN是一种有效的技术，可减少外固定所需时间。
