Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, Guangdong, China.
Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium.
J Orthop Surg Res. 2023 Apr 5;18(1):277. doi: 10.1186/s13018-023-03659-y.
The traction table is generally used in femoral intramedullary nailing surgery. Recently, some published studies have shown that the same or better treatment effects can be gotten without a traction table. It remains no consensus on this issue.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was applied in this study. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for eligible studies. The random-effect model was used to calculate the standardized mean difference (SMD) and risk ratios with 95% CIs. Trial sequential analysis (TSA) was performed to verify the results.
The pooled estimates of seven studies, including 266 cases each in the manual traction group and traction table group, indicated that manual traction could shorten operative time [SMD, - 0.77; 95% CI (- 0.98, - 0.55); P < 0.00001] and preoperative set-up time [SMD, - 2.37; 95% CI (- 3.90, - 0.84); P = 0.002], but it would not reduce intraoperative blood loss volume and fluoroscopy time. No statistical difference was found in their fracture healing time, postoperative Harris scores, and malunion rate. The use of a Traction repositor could reduce the set-up time [SMD, - 2.48; 95% CI (- 4.91, - 0.05); P < 0.00001].
Compared with manual traction, the traction table in femoral intramedullary nailing surgery lengthened operative time and preoperative set-up time. At the same time, it did not show significant advantages in reducing blood loss volume and fluoroscopy time, or improving prognosis. In clinical practice, the optimal surgical plan must be made on a case-by-case basis to avoid unnecessary traction table use.
牵引台通常用于股骨髓内钉手术。最近，一些已发表的研究表明，不使用牵引台也可以获得相同或更好的治疗效果。目前对此问题尚未达成共识。
本研究采用系统评价和荟萃分析的首选报告项目。我们检索了 PubMed、Embase、Web of Science 和 Cochrane Library 数据库中符合条件的研究。使用随机效应模型计算标准化均数差（SMD）和风险比（RR）及其 95%置信区间（CI）。进行试验序贯分析（TSA）以验证结果。
纳入的 7 项研究共 266 例，分别为手动牵引组和牵引台组，汇总估计值表明手动牵引可以缩短手术时间[SMD，-0.77；95%CI（-0.98，-0.55）；P<0.00001]和术前准备时间[SMD，-2.37；95%CI（-3.90，-0.84）；P=0.002]，但不会减少术中失血量和透视时间。两组的骨折愈合时间、术后 Harris 评分和畸形愈合率无统计学差异。使用牵引复位器可以减少准备时间[SMD，-2.48；95%CI（-4.91，-0.05）；P<0.00001]。
与手动牵引相比，股骨髓内钉手术中使用牵引台会延长手术时间和术前准备时间。同时，在减少失血量和透视时间、改善预后方面没有明显优势。在临床实践中，必须根据具体情况制定最佳手术方案，避免不必要地使用牵引台。
