增强钢板技术治疗下肢长骨髓内钉固定术后骨不连的有效性和安全性：一项系统评价和荟萃分析。

Effectiveness and safety of augmentative plating technique in managing nonunion following intramedullary nailing of long bones in the lower extremity: A systematic review and meta-analysis.

作者信息

Fu Cong-Xiao, Gao Hao, Ren Jun, Wang Hu, Lu Shuai-Kun, Wang Guo-Liang, Zhu Zhen-Feng, Liu Yun-Yan, Luo Wen, Zhang Yong, Zhang Yun-Fei

机构信息

Xi'an Medical University, Xi'an, 710021, China.

Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China.

出版信息

Chin J Traumatol. 2025 May;28(3):164-174. doi: 10.1016/j.cjtee.2024.04.004. Epub 2024 Apr 27.

DOI:10.1016/j.cjtee.2024.04.004

PMID:38762419

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12166877/

Abstract

PURPOSE

To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.

METHODS

PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3.

RESULTS

This meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (CI): 4.12 - 17.99, p < 0.001), shorter union time (standardized mean difference (SMD): -1.08, 95% CI: -1.79 - -0.37, p = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95% CI: -0.93 - -0.19, p = 0.003), less bleeding (SMD: -1.5, 95% CI: -2.81 - -0.18, p = 0.03), and a lower incidence of complications (relative risk: -0.17, 95% CI: -0.27 - -0.06, p = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95% CI: -3.28 - -0.61, p < 0.001; isthmal SMD: -1.08, 95% CI: -1.64 - -0.52, p = 0.002).

CONCLUSION

In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.

摘要

目的

系统评估增强钢板固定术（AP）和交锁髓内钉更换术（EN）在治疗下肢长骨骨折髓内钉固定术后骨不连方面的有效性。

方法

检索PubMed、EMBASE、科学网和Cochrane图书馆，收集关于AP和EN技术用于治疗下肢长骨髓内钉固定术后骨不连的临床研究。检索截至2023年5月。对原始研究进行独立的质量评估，该过程采用纽卡斯尔-渥太华量表进行。从这些研究中检索数据，并使用Review Manager 5.3进行荟萃分析。

结果

该荟萃分析纳入了8项研究，共661名参与者，其中AP组305名，EN组356名。荟萃分析结果表明，AP组的骨愈合率更高（优势比：8.61，95%置信区间（CI）：4.12 - 17.99，p < 0.001），骨愈合时间更短（标准化均数差（SMD）：-1.08，95% CI：-1.79 - -0.37，p = 0.003），手术时间缩短（SMD：-0.56，95% CI：-0.93 - -0.19，p = 0.003），出血量更少（SMD：-1.5，95% CI：-2.81 - -0.18，p = 0.03），并发症发生率更低（相对风险：-0.17，95% CI：-0.27 - -0.06，p = 0.001）。在亚组分析中，与EN组相比，AP组在下肢长骨非峡部和峡部骨不连的骨愈合时间更短（非峡部SMD：-1.94，95% CI：-3.28 - -0.61，p < 0.001；峡部SMD：-1.08，95% CI：-1.64 - -0.52，p = 0.002）。