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髓内钉固定与切开复位内固定治疗成人骨干前臂骨折：系统评价和荟萃分析。

Intramedullary nail fixation versus open reduction and internal fixation for treatment of adult diaphyseal forearm fractures: a systematic review and meta-analysis.

机构信息

Department of Orthopaedic Surgery, Medical City Denton, Denton, TX, USA.

Department of Orthopaedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

出版信息

J Orthop Surg Res. 2024 Nov 4;19(1):719. doi: 10.1186/s13018-024-05158-0.

DOI:10.1186/s13018-024-05158-0
PMID:39497147
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11533272/
Abstract

BACKGROUND

Diaphyseal radius and ulna fractures require surgical fixation in adults. Open reduction and internal fixation (ORIF) have been considered the gold standard of treatment. The recent development of an interlocking intramedullary nail (IMN) has provided an alternative treatment method for these fractures. The objective of this meta-analysis is to compare the outcomes and complications of IMN versus ORIF for diaphyseal forearm fractures in adults.

METHODS

MEDLINE and Embase were searched from January 1, 2000, through January 7, 2024. All English-language studies were included comparing radiographic and functional outcomes for interlocking IMN fixation and ORIF of diaphyseal forearm fractures in adults (age ≥ 18 years). Study demographics, fracture data, functional outcomes, radiographic outcomes, and complications were extracted. Study quality was determined using the ROBINS-I criteria for cohort studies and the Cochrane risk of bias 2.0 (RoB 2) tool for randomized controlled trials. Meta-analysis of included studies used odds ratios and standardized mean difference when appropriate. Data was analyzed using subgroups of all diaphyseal fractures (including isolated radius or ulna fractures) and those with BBFFs.

RESULTS

Nine studies were included for analysis. There were 42 isolated radius, 80 isolated ulna, and 116 both-bone fractures (BBFF) treated with IMN and 36 radius, 81 ulna, and 116 both-bone fractures treated with ORIF. Compared to ORIF, IMN of diaphyseal forearm fractures appeared to be associated with shorter operative times and a lower overall complication rate. Time-to-union and the rate of nonunion following IMN were similar to ORIF. According to the Grace-Eversmann score, functional outcomes tended to be better following IMN, but DASH scores were similar between fixation strategies.

CONCLUSIONS

Our findings suggest that interlocking IMN can be a safe and effective treatment option for simple and complex diaphyseal forearm fractures in adults. Further high-quality studies are needed to define indications for treating diaphyseal fractures with an interlocking IMN.

LEVEL OF EVIDENCE

Therapeutic Level IV.

摘要

背景

骨干桡骨和尺骨骨折需要在成人中进行手术固定。切开复位内固定（ORIF）被认为是治疗的金标准。最近，一种带锁髓内钉（IMN）的发展为这些骨折提供了一种替代的治疗方法。本荟萃分析的目的是比较 IMN 与 ORIF 治疗成人骨干前臂骨折的结果和并发症。

方法

从 2000 年 1 月 1 日至 2024 年 1 月 7 日，检索了 MEDLINE 和 Embase。纳入了所有比较带锁 IMN 固定与成人骨干前臂骨折 ORIF 的影像学和功能结果的英文研究（年龄≥18 岁）。提取研究人口统计学、骨折数据、功能结果、影像学结果和并发症。使用 ROBINS-I 标准评估队列研究的研究质量，使用 Cochrane 风险偏倚 2.0（RoB 2）工具评估随机对照试验的研究质量。当合适时，使用比值比和标准化均数差对纳入研究进行荟萃分析。使用所有骨干骨折（包括孤立的桡骨或尺骨骨折）和双骨折（BBFF）的亚组进行数据分析。

结果

纳入 9 项研究进行分析。42 例孤立桡骨、80 例孤立尺骨和 116 例双骨骨折（BBFF）接受 IMN 治疗，36 例桡骨、81 例尺骨和 116 例双骨骨折接受 ORIF 治疗。与 ORIF 相比，IMN 治疗骨干前臂骨折似乎与较短的手术时间和较低的总体并发症发生率相关。IMN 后愈合时间和非愈合率与 ORIF 相似。根据 Grace-Eversmann 评分，IMN 后的功能结果往往更好，但固定策略之间的 DASH 评分相似。

结论

我们的研究结果表明，带锁髓内钉可作为成人简单和复杂骨干前臂骨折的一种安全有效的治疗选择。需要进一步进行高质量的研究，以确定用带锁髓内钉治疗骨干骨折的适应证。

证据水平

治疗性 IV 级。

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