两种方法治疗股骨干髓内钉固定后骨不连的荟萃分析
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摘要
[目的]比较保留髓内钉附加侧板与更换髓内钉治疗股骨干骨折髓内钉固定后的骨不连的疗效。[方法]运用计算机检索EMBASE、PubMed、Cochrane Library、Clinical databases、中国知网和万方数据库,收集2018年4月前国内外公开发表的有关保留髓内钉附加侧板与更换髓内钉治疗股骨干骨折髓内钉固定后的骨不连的临床疗效对比的文献。通过阅读标题、摘要与全文,剔除无关文献,严格评价纳入研究的方法学质量,并提取有关数据,并用RevMan5.3软件进行统计分析。[结果]本研究共纳入了19个研究报告,共有1 239位患者,其中保留髓内钉附加侧板治疗组608例,更换髓内钉治疗组634例。荟萃分析结果显示,保留髓内钉附加侧板组较更换髓内钉组手术时间更短(P<0.001),术中出血更少(P<0.001)。此外,保留髓内钉附加侧板组较更换髓内钉组骨不连愈合率更高(P<0.001)、骨不连的愈合时间更短(P<0.001),但是两组术后感染率方面差异无统计学意义(P>0.05)。[结论]保留髓内钉附加侧板治疗股骨干骨折髓内钉固定后的骨不连相对于更换髓内钉具有更好的疗效。
[Objective] To compare of clinical outcomes of exchange nailing versus augmentation plating for femoral shaft nonunion after intramedullary nailing. [Methods] The electronic databases were searched before April 2018, including EMBASE, PubMed, Cochrane library, Clinical, WFSD and CNKI databases, for published researches on exchange nailing versus augmentation plating for femoral shaft nonunion after intramedullary nailing. After a thorough evaluation of methodological quality, a meta-analysis was conducted on the included data by using RevMan 5.3 software. [Results] A total of 19 papers were enrolled into this analysis, involving 1 239 patients including 608 patients treated with augmentation plating and 634 patients treated with exchange nailing. As results of this meta-analysis, the augmentation plating group consumed significantly less operation time, associated with significantly less intraoperative blood loss than the exchange nailing group(P<0.001). In addition,the augmentation plating group achieved significantly higher bony healing rate, associated with significantly shorter time elapsed for healing of the nonunion fracture than the exchange nailing group(P<0.001), although no a statistically significant difference was proved in infection rate between them(P>0.05). [Conclusion] The available evidence has shown that the augmentation plating is superior to the exchange nailing for femoral shaft nonunion after intramedullary nailing.
[Objective] To compare of clinical outcomes of exchange nailing versus augmentation plating for femoral shaft nonunion after intramedullary nailing. [Methods] The electronic databases were searched before April 2018, including EMBASE, PubMed, Cochrane library, Clinical, WFSD and CNKI databases, for published researches on exchange nailing versus augmentation plating for femoral shaft nonunion after intramedullary nailing. After a thorough evaluation of methodological quality, a meta-analysis was conducted on the included data by using RevMan 5.3 software. [Results] A total of 19 papers were enrolled into this analysis, involving 1 239 patients including 608 patients treated with augmentation plating and 634 patients treated with exchange nailing. As results of this meta-analysis, the augmentation plating group consumed significantly less operation time, associated with significantly less intraoperative blood loss than the exchange nailing group(P<0.001). In addition,the augmentation plating group achieved significantly higher bony healing rate, associated with significantly shorter time elapsed for healing of the nonunion fracture than the exchange nailing group(P<0.001), although no a statistically significant difference was proved in infection rate between them(P>0.05). [Conclusion] The available evidence has shown that the augmentation plating is superior to the exchange nailing for femoral shaft nonunion after intramedullary nailing.
引文
[1] Winquist RA, Hansen ST, Jr DK. Clawson, Closed intramedullary nailing of femoral fractures. a report of five hundred and twenty cases[J]. J Bone Joint Surg Am, 1984, 66(4):529-539.
[2] Brumback RJ, Uwagie-ero S, Lakatos RP, et al. Intramedullary nailing of femoral shaft fractures. Part II:fracture-healing with static interlocking fixation[J]. J Bone Joint Surg Am, 1988, 70(10):1453-1462.
[3] Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures[J]. J Orthop Trauma, 2002, 16(6):394-402.
[4] Wu CC, Chen WJ. Exchange nailing for aseptic nonunion of the femoral shaft[J]. Int Orthop, 2002, 26(2):80-84.
[5] Furlong AJ, Giannoudis PV, DeBoer P, et al. Exchange nailing for femoral shaft aseptic non-union[J]. Injury, 1999, 30(4):245-249.
[6] Weresh WJ, Hakanson R, Stover MD, et al. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures[J]. J Orthop Trauma, 2000, 14(5):335-338.
[7] Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-chabock H.Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing[J]. Orthopedics, 2009, 32(6):409.
[8] Kim JR, Chung WC, Shin SJ, et al. The management of aseptic nonunion of femoral shaft fractures after interlocking intramedullary nailing[J]. Europ J Orthop Surg Traumatol, 2011, 21(3):171-177.
[9] Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating[J]. J Orthop Trauma, 2010, 24(2):89-94.
[10] Ru J, Xu H, Kang W, et al. Augmentative compression plating versus exchanging reamed nailing for nonunion of femoral shaft fracture after intramedullary nailing:a retrospective cohort study[J].Acta Orthop Belgica, 2016, 82(2):249-257.
[11]曾周景,叶建华,谭通,等.保留髓内钉附加侧板在股骨干非峡部段骨不连中的应用[J].中华骨与关节外科杂志, 2015, 8(3):260-262.
[12]黄振勇,黄振建.股骨干骨折髓内钉固定后非感染性骨不连应用不同方法治疗的疗效研究[J].内蒙古中医药, 2014, 33(20):105.
[13]李红国.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效比较[J].中国医药指南, 2013(24):554-555.
[14]刘思景,郑臣校,郑雨中,等.两种手术方式治疗股骨干骨折交锁髓内钉固定术后骨折不愈合的临床疗效比较[J].中国实用医药,2017,12(33):54-55.
[15]卢永.更换髓内钉和保留髓内钉、附加侧板治疗股骨干骨折髓内钉固定术后非感染性骨不连的疗效[J].中国医学工程,2015, 23(3):86-87.
[16]马怀军.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效对比[J].当代临床医刊, 2016, 29(3):2235.
[17]马锦鹏,冯庆全.股骨干骨折髓内钉术后骨不连应用自体骨植骨、ERN和ACP的疗效分析[J].深圳中西医结合杂志, 2018,28(4):163-164.
[18]马量,胡英彦,曾海龙,等.保留髓内钉附加侧板治疗股骨干非峡部段骨不连的临床疗效研究[J].中国伤残医学, 2014, 22(9):94-95.
[19]缪海雄,孙春汉,王斌,等.更换髓内钉与髓内钉联合侧方钢板治疗股骨干非峡部肥大型骨不连的疗效比较[J].中华创伤骨科杂志, 2013,(9):820-821.
[20]慕志广.附加侧板联合植骨治疗股骨干骨折髓内钉固定后骨不连的效果分析[J].医学理论与实践, 2016, 29(16):2214-2215.
[21]乔广奎.保留髓内钉附加侧板治疗股骨干非峡部段骨不连的临床疗效研究[J].中国伤残医学, 2015,(19):51-52.
[22]孙凯,史智军.保留髓内钉附加侧板治疗股骨干非峡部段骨不连临床分析[J].吉林医学, 2014, 35(36):8018-8019.
[23]薛佳木,李宝双,赵志忠. 2种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的效果对比研究[J].当代医学, 2018, 24(2):34-36.
[24]张道鑫,韩庆斌,李猛,等.抗旋钢板治疗股骨干骨折术后骨不连的临床研究[J].当代临床医刊, 2018,(2):3711-3712.
[25]郑志雄,吴强初,蓝声远.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效对比研究[J].世界临床医学,2017,(7):80-82.
[26]邹运璇,朱永展,吴峰,等.更换髓内钉与附加钢板治疗股骨干骨折术后骨不连的疗效比较[J].中国骨与关节损伤杂志,2016,(8):850-851.
[27]L.S. Boyd HB, Wiley JH, Observation on nonunion of the shafts of the long bones, with a statistical analysis of 842 patients[J]. J Bone Joint Surg Am, 1961, 43:159-168.
[28] Brumback RJ. The rationales of interlocking nailing of the femur,tibia, and humerus[J]. Clin Orthop, 1996,(324):292-320.
[29] Brinker MR, O'Connor DP. Exchange nailing of ununited fractures[J]. J Bone Joint Surg Am, 2007, 89(1):177-188.
[30] Banaszkiewicz PA, Sabboubeh A, McLeod I, et al. Femoral exchange nailing for aseptic non-union:not the end to all problems[J]. Injury, 2003, 34(5):349-356.
[31] Chen CM, Su YP, Hung SH, et al. Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture[J]. Orthopedics, 2010, 33(6):393.
[32] Vaishya R, Agarwal AK, Gupta N, et al. Plate augmentation with retention of intramedullary nail is effective for resistant femoral shaft non-union[J]. J Orthop, 2016, 13(4):242-245.
[2] Brumback RJ, Uwagie-ero S, Lakatos RP, et al. Intramedullary nailing of femoral shaft fractures. Part II:fracture-healing with static interlocking fixation[J]. J Bone Joint Surg Am, 1988, 70(10):1453-1462.
[3] Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures[J]. J Orthop Trauma, 2002, 16(6):394-402.
[4] Wu CC, Chen WJ. Exchange nailing for aseptic nonunion of the femoral shaft[J]. Int Orthop, 2002, 26(2):80-84.
[5] Furlong AJ, Giannoudis PV, DeBoer P, et al. Exchange nailing for femoral shaft aseptic non-union[J]. Injury, 1999, 30(4):245-249.
[6] Weresh WJ, Hakanson R, Stover MD, et al. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures[J]. J Orthop Trauma, 2000, 14(5):335-338.
[7] Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-chabock H.Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing[J]. Orthopedics, 2009, 32(6):409.
[8] Kim JR, Chung WC, Shin SJ, et al. The management of aseptic nonunion of femoral shaft fractures after interlocking intramedullary nailing[J]. Europ J Orthop Surg Traumatol, 2011, 21(3):171-177.
[9] Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating[J]. J Orthop Trauma, 2010, 24(2):89-94.
[10] Ru J, Xu H, Kang W, et al. Augmentative compression plating versus exchanging reamed nailing for nonunion of femoral shaft fracture after intramedullary nailing:a retrospective cohort study[J].Acta Orthop Belgica, 2016, 82(2):249-257.
[11]曾周景,叶建华,谭通,等.保留髓内钉附加侧板在股骨干非峡部段骨不连中的应用[J].中华骨与关节外科杂志, 2015, 8(3):260-262.
[12]黄振勇,黄振建.股骨干骨折髓内钉固定后非感染性骨不连应用不同方法治疗的疗效研究[J].内蒙古中医药, 2014, 33(20):105.
[13]李红国.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效比较[J].中国医药指南, 2013(24):554-555.
[14]刘思景,郑臣校,郑雨中,等.两种手术方式治疗股骨干骨折交锁髓内钉固定术后骨折不愈合的临床疗效比较[J].中国实用医药,2017,12(33):54-55.
[15]卢永.更换髓内钉和保留髓内钉、附加侧板治疗股骨干骨折髓内钉固定术后非感染性骨不连的疗效[J].中国医学工程,2015, 23(3):86-87.
[16]马怀军.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效对比[J].当代临床医刊, 2016, 29(3):2235.
[17]马锦鹏,冯庆全.股骨干骨折髓内钉术后骨不连应用自体骨植骨、ERN和ACP的疗效分析[J].深圳中西医结合杂志, 2018,28(4):163-164.
[18]马量,胡英彦,曾海龙,等.保留髓内钉附加侧板治疗股骨干非峡部段骨不连的临床疗效研究[J].中国伤残医学, 2014, 22(9):94-95.
[19]缪海雄,孙春汉,王斌,等.更换髓内钉与髓内钉联合侧方钢板治疗股骨干非峡部肥大型骨不连的疗效比较[J].中华创伤骨科杂志, 2013,(9):820-821.
[20]慕志广.附加侧板联合植骨治疗股骨干骨折髓内钉固定后骨不连的效果分析[J].医学理论与实践, 2016, 29(16):2214-2215.
[21]乔广奎.保留髓内钉附加侧板治疗股骨干非峡部段骨不连的临床疗效研究[J].中国伤残医学, 2015,(19):51-52.
[22]孙凯,史智军.保留髓内钉附加侧板治疗股骨干非峡部段骨不连临床分析[J].吉林医学, 2014, 35(36):8018-8019.
[23]薛佳木,李宝双,赵志忠. 2种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的效果对比研究[J].当代医学, 2018, 24(2):34-36.
[24]张道鑫,韩庆斌,李猛,等.抗旋钢板治疗股骨干骨折术后骨不连的临床研究[J].当代临床医刊, 2018,(2):3711-3712.
[25]郑志雄,吴强初,蓝声远.两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效对比研究[J].世界临床医学,2017,(7):80-82.
[26]邹运璇,朱永展,吴峰,等.更换髓内钉与附加钢板治疗股骨干骨折术后骨不连的疗效比较[J].中国骨与关节损伤杂志,2016,(8):850-851.
[27]L.S. Boyd HB, Wiley JH, Observation on nonunion of the shafts of the long bones, with a statistical analysis of 842 patients[J]. J Bone Joint Surg Am, 1961, 43:159-168.
[28] Brumback RJ. The rationales of interlocking nailing of the femur,tibia, and humerus[J]. Clin Orthop, 1996,(324):292-320.
[29] Brinker MR, O'Connor DP. Exchange nailing of ununited fractures[J]. J Bone Joint Surg Am, 2007, 89(1):177-188.
[30] Banaszkiewicz PA, Sabboubeh A, McLeod I, et al. Femoral exchange nailing for aseptic non-union:not the end to all problems[J]. Injury, 2003, 34(5):349-356.
[31] Chen CM, Su YP, Hung SH, et al. Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture[J]. Orthopedics, 2010, 33(6):393.
[32] Vaishya R, Agarwal AK, Gupta N, et al. Plate augmentation with retention of intramedullary nail is effective for resistant femoral shaft non-union[J]. J Orthop, 2016, 13(4):242-245.
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