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骨骼未成熟患者双侧前臂骨折的髓内固定与钢板固定：一项系统评价和荟萃分析

Intramedullary versus plate fixation of both bone forearm fractures in skeletally immature patients: a systematic review and meta-analysis.

作者信息

Ahmed Ahmed Mohamed, Said Elsayed, Addosooki Ahmad, Attya Hossam Ahmed, Awad Ahmad Khairy, Ahmed Emad Hamdy, Tammam Hamdy

机构信息

Department of Orthopaedic Surgery and Traumatology, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, Egypt.

Department of Orthopaedic Surgery and Traumatology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.

出版信息

Eur J Orthop Surg Traumatol. 2024 Jul;34(5):2263-2278. doi: 10.1007/s00590-024-03925-7. Epub 2024 Apr 20.

DOI:10.1007/s00590-024-03925-7
PMID:38642124
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11291663/
Abstract

BACKGROUND

Both bone forearm fractures (BBFFs) are a common injury amongst the pediatric population. The main indications of surgical fixation are open, irreducible, or unstable fractures. The two most commonly used surgical techniques are closed or open reduction with intramedullary fixation (IMF) and open reduction with plate fixation (PF). The aim of this systematic review and meta-analysis was to determine which fixation method is superior for BBFFs.

METHODS

PubMed, Scopus, Web of Science, and CENTRAL were searched to identify studies comparing IMF and PF. We extracted data on union rates, complications, early hardware removal rates, reoperation rates, and radiographic, clinical, and perioperative outcomes.

RESULTS

Sixteen studies were included in the analysis, with a total of 922 patients (539 IMF and 383 PF). Similar union rates were achieved by both fixation technique. IMF was associated with a higher incidence of symptomatic hardware, and early hardware removal. Better restoration of the radial bow was observed with the PF group, especially in older children and adolescents. The rate of excellent function was comparable between groups, whereas better cosmesis was reported with the IMF group. Despite shorter fluoroscopy time and immobilization time, PF demonstrated longer tourniquet time, operating time, and hospital stay compared to IMF.

CONCLUSIONS

We found no significant difference between IMF and PF in terms of union rates and functional outcomes taking in consideration the merits and demerits of each technique. High-quality randomized controlled trials are, therefore, necessary to determine the superiority of one fixation technique over the other.

LEVEL OF EVIDENCE

III.

摘要

背景

双侧尺桡骨骨折（BBFFs）是儿科人群中的常见损伤。手术固定的主要指征是开放性、不可复位或不稳定骨折。两种最常用的手术技术是闭合或切开复位髓内固定（IMF）和切开复位钢板固定（PF）。本系统评价和荟萃分析的目的是确定哪种固定方法对BBFFs更具优势。

方法

检索PubMed、Scopus、科学网和CENTRAL，以识别比较IMF和PF的研究。我们提取了关于骨愈合率、并发症、早期内固定取出率、再次手术率以及影像学、临床和围手术期结果的数据。

结果

16项研究纳入分析，共922例患者（539例接受IMF，383例接受PF）。两种固定技术的骨愈合率相似。IMF与有症状内固定物及早期内固定物取出的发生率较高相关。PF组桡骨弓形恢复更好，尤其是在大龄儿童和青少年中。两组间优良功能率相当，而IMF组的美容效果更佳。尽管PF的透视时间和固定时间较短，但与IMF相比，其止血带时间、手术时间和住院时间更长。

结论

考虑到每种技术的优缺点，我们发现IMF和PF在骨愈合率和功能结果方面无显著差异。因此，需要高质量的随机对照试验来确定一种固定技术相对于另一种的优越性。

证据级别

III级。

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本文引用的文献

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Cureus. 2023 Aug 16;15(8):e43557. doi: 10.7759/cureus.43557. eCollection 2023 Aug.
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An age-matched comparative study on intramedullary nailing and plate fixation of both-bone diaphyseal forearm fracture in adolescents.青少年双骨干前臂骨折髓内钉与钢板固定的年龄匹配对照研究。
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):441-450. doi: 10.1007/s00590-023-03679-8. Epub 2023 Aug 13.
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Comparison of Three Different Surgical Fixation Techniques in Pediatric Forearm Double Fractures.
三种不同手术固定技术治疗小儿前臂双骨折的比较
Cureus. 2021 Aug 6;13(8):e16931. doi: 10.7759/cureus.16931. eCollection 2021 Aug.
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Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature.小儿前臂骨折的治疗：最佳治疗选择是什么？文献综述的叙述性评价。
Musculoskelet Surg. 2021 Dec;105(3):225-234. doi: 10.1007/s12306-020-00684-6. Epub 2020 Oct 14.
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A comparison of fixation methods in adolescent patients with diaphyseal forearm fractures.青少年尺桡骨干骨折患者固定方法的比较
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Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review.处理荟萃分析中连续结局缺失标准差和均数值的方法：系统评价。
BMC Med Res Methodol. 2018 Mar 7;18(1):25. doi: 10.1186/s12874-018-0483-0.
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Comparison of three surgical fixation methods for dual-bone forearm fractures in older children: A retrospective cohort study.三种手术固定方法治疗大龄儿童双前臂骨折的比较：一项回顾性队列研究。
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Increasing rates of surgical treatment for paediatric diaphyseal forearm fractures: a National Database Study from 2000 to 2012.儿童尺桡骨干骨折手术治疗率的上升：一项2000年至2012年的全国数据库研究
J Child Orthop. 2017 Jun 1;11(3):201-209. doi: 10.1302/1863-2548.11.170017.
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