Liu Wanlin, Li Wenqiang, Bai Rui, Xu Xiangyu, Zhao Zhenqun, Wang Yan
Department of Orthopaedic, The Second Affiliated Hospital of Inner Mongolia, Medical University, Hohhot, 010030 Inner Mongolia China.
Department of Inner Mongolia Medical University, Hohot, 010030 Inner Mongolia China.
Indian J Orthop. 2024 Mar 16;58(5):484-494. doi: 10.1007/s43465-024-01125-3. eCollection 2024 May.
Elastic stable intramedullary nailing (ESIN) and plates are currently the main internal fixation for treating Pediatric Diaphyseal Femur Fractures (PDFF), and the optimal choice of internal fixation is controversial. The purpose of this meta-analysis is to compare the surgical outcomes and complications of the two fixation methods.
MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to March, 2023, that compared ESIN and plate fixation techniques for treating PDFF. Pooled analysis identified differences in surgical outcomes between ESIN and plate, mainly regarding surgical outcomes and postoperative complications, such as time at surgery, fracture healing time, blood loss and related complications.
We included 10 studies with 775 patients with PDFF in our review. Of these, 428 and 347 were treated with ESIN and Plate, respectively. In terms of postoperative complications, ESIN led to a shorter surgery time [MD = - 28.93, 95% CI (- 52.88 to - 4.98), < 0.05], less blood loss [MD = - 66.94, 95% CI (- 87.79 to - 46.10), < 0.001] and more fracture healing time [MD = 2.65, 95% CI (1.22-4.07), < 0.001]. In terms of postoperative complications, ESIN led to fewer fections (RR = 0.77, 95% CI 0.37, 1.60, = 0.48), fewer angulation deformities (RR = 0.80, 95% CI 0.35, 1.83, = 0.60) and more prominent implants (RR = 3.36, 95% CI 1.88, 6.01, < 0.001), more delayed unions (RR = 4.06, 95% CI 0.71, 23.06, = 0.11).
ESIN and Plate have similar rates of complications besides a prominent implant rate, while ESIN has a shorter period of operation and less intraoperative bleeding. Although both options are suitable, the results of this study support the use of ESIN rather than plates in the treatment of PDFF in terms of complication rates. In clinical applications, surgeons should choose the appropriate treatment method according to the actual situation.
弹性稳定髓内钉（ESIN）和钢板目前是治疗小儿股骨干骨折（PDFF）的主要内固定方法，内固定的最佳选择存在争议。本荟萃分析的目的是比较两种固定方法的手术效果和并发症。
系统检索MEDLINE、Embase和Cochrane图书馆截至2023年3月发表的比较ESIN和钢板固定技术治疗PDFF的研究。汇总分析确定了ESIN和钢板在手术效果方面的差异，主要涉及手术效果和术后并发症，如手术时间、骨折愈合时间、失血量及相关并发症。
我们的综述纳入了10项研究，共775例PDFF患者。其中，分别有428例和347例接受了ESIN和钢板治疗。在术后并发症方面，ESIN导致手术时间更短[MD = - 28.93，95%CI（- 52.88至- 4.98），P < 0.05]，失血量更少[MD = - 66.94，95%CI（- 87.79至- 46.10），P < 0.001]，骨折愈合时间更长[MD = 2.65，95%CI（1.22 - 4.07），P < 0.001]。在术后并发症方面，ESIN导致感染更少（RR = 0.77，95%CI 0.37，1.60，P = 0.48），成角畸形更少（RR = 0.80，95%CI 0.35，1.83，P = 0.60），植入物突出更明显（RR = 3.36，95%CI 1.88，6.01，P < 0.001），延迟愈合更多（RR = 4.06，95%CI 0.71，23.06，P = 0.11）。
除了植入物突出率外，ESIN和钢板的并发症发生率相似，而ESIN的手术时间更短，术中出血更少。虽然两种选择都合适，但就并发症发生率而言，本研究结果支持在治疗PDFF时使用ESIN而非钢板。在临床应用中，外科医生应根据实际情况选择合适的治疗方法。
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