Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, United Kingdom.
Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom.
Surgeon. 2019 Oct;17(5):257-269. doi: 10.1016/j.surge.2018.08.003. Epub 2018 Aug 27.
and purpose: We have undertaken a systematic review to evaluate the clinical results of intramedullary nailing (IMN) for open diaphyseal femoral fractures on the rates of union, delayed union, malunion, superficial and deep infection and bone grafting.
We searched the electronic databases of EMBASE, MEDLINE, from their inception until December 1st, 2017 with no language restrictions. The reference lists of all included articles and relevant reviews were also examined for potentially eligible studies. Hand search using electronic database of recent major orthopaedic journals was also carried. Two reviewers working independently extracted study characteristics and data to estimate the diagnostic odds ratio and 95% confidence interval for each result.
Seventeen studies were eligible. Pooled estimate of effect size for union rate was 97% (95% CI: 94-99%). Deep infection rate was 6% (95% CI: 3-9.3%) and more prominent in Gustilo type III injuries; superficial infection was 5.6% (95% CI: 3-9.3%). Delayed union rate 3% (95% CI: 1-5.6%) while, malunion rate was 8.4% (95% CI: 5.7-11.6%). The need for bone grafting ranged from 0 to 9%.
IMN remains the treatment of choice for open femoral diaphyseal fractures with very good union rates. Gustilo grade III injuries demonstrate a distinct higher deep infection rate and strict adherence to established surgical debridement and fixation protocols is advocated. The need for bone grafting can be as high as 9% and patients should be made aware of the possibility of requiring this additional procedure.
我们进行了一项系统评价，评估髓内钉（IMN）治疗开放性股骨干骨折的临床结果，包括愈合率、延迟愈合率、畸形愈合率、浅表和深部感染以及植骨率。
我们检索了 EMBASE 和 MEDLINE 电子数据库，检索时间从建库至 2017 年 12 月 1 日，无语言限制。还查阅了所有纳入文章和相关综述的参考文献列表，以寻找可能符合条件的研究。还对手头使用的最近主要骨科杂志的电子数据库进行了手工搜索。两名独立的审查员提取研究特征和数据，以估计每个结果的诊断优势比和 95%置信区间。
17 项研究符合条件。愈合率的合并估计效应大小为 97%（95%CI：94-99%）。深部感染率为 6%（95%CI：3-9.3%），在 Gustilo Ⅲ型损伤中更为明显；浅表感染率为 5.6%（95%CI：3-9.3%）。延迟愈合率为 3%（95%CI：1-5.6%），而畸形愈合率为 8.4%（95%CI：5.7-11.6%）。植骨的需求从 0 到 9%不等。
IMN 仍然是治疗开放性股骨干骨折的首选方法，具有非常高的愈合率。Gustilo Ⅲ型损伤显示出明显较高的深部感染率，因此强烈建议严格遵循既定的手术清创和固定方案。植骨的需求可能高达 9%，应告知患者有可能需要进行这一额外的手术。
