可延长髓内钉治疗儿童成骨不全下肢骨折效果的Meta分析
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摘要
目的针对可延长髓内钉治疗儿童成骨不全下肢骨折的相关文献进行Meta分析,对该内固定方法的安全性进行系统评价。方法检索Pub Med、Em Base、Cochrane图书馆、万方数据资源系统、中国期刊网全文数据库中有关可延长髓内钉治疗成骨不全(osteogenesis imperfecta,OI)患儿下肢骨折的文献,筛选后将文献中报道的随访结果相关数据进行提取,采用Stata10. 0进行Meta分析。结果最终纳入的文献共8篇,研究对象为258例经可延长髓内固定的OI患儿下肢骨,其中股骨157例,胫骨101例;患儿年龄范围为3. 1～8. 0岁,术后随访时间为17～228个月。合并分析后得出术后钉相关并发症发生率为25. 00%(95%CI:15. 00%～34. 00%),主要为钉移位,Egger和Begg检验结果显示无发表偏倚(P_(Egger)=0. 248,P_(Begg)=0. 386);骨相关并发症发生率为16. 00%(95%CI:9. 00%～23. 00%),主要为再骨折,Egger和Begg检验结果显示可能存在发表偏倚(P_(Egger)=0. 040,P_(Begg)=0. 086);而再手术率的研究分析得出其发生率约23. 00%(95%CI:12. 00%～35. 00%),Egger和Begg检验结果显示无发表偏倚(P_(Egger)=0. 734,P_(Begg)=0. 806)。结论钉移位和再骨折是可延长髓内钉治疗OI患儿下肢骨折术后的主要并发症,但与非延长髓内钉治疗组相比发生率显著降低,随着内固定系统的不断完善,该手术方法将帮助OI患儿获得更好的生活质量。
Objective To evaluate the safety profile of elongating intramedullary rods for lower extremity fractures in osteogenesis imperfect( OI) children to provide rationales for future application in China. Methods We systematically searched the electronic databases of Pub Med,Em Base,Cochrane library,Wanfang Data Resource System of Digital Periodicals and Chinese Journal Full text Database with the inception of January2018. All processes followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses( PRISMA). And inclusion and exclusion standards were implemented. The summary results were calculated by a random effect model. Results A total of 8 studies were included into the final cohort. There were 258 lower extremities using the elongating intramedullary rod approach. The mean age was 3. 1-8. 0 years and the follow-up period 17-228 months. The rate of rod-related complications was 25. 00%( 95% CI: 15. 00%-34. 00%) and most cases were related with rod migration( 13. 54%). Egger and Begg tests showed no significant publication bias( P_(Egger): 0. 248; P_(Begg): 0. 386). The rate of bone-related complications was 16. 00%( 95% CI: 9. 00%-23. 00%) and refractures were predominant( 8. 43%). However,Egger and Begg tests showed significant publication bias( P_(Egger): 0. 040; P_(Begg): 0. 086). The reoperative rate was 23. 00%( 95% CI: 12. 00%-35. 00%).And Egger and Begg tests also showed no significant publication bias( P_(Egger): 0. 734; P_(Begg): 0. 806). Conclusion During elongating intramedullary rod in OI surgery,rod migration and refracture remain two major postoperative complications. However,comparing with nonelongating intramedullary rodding,the efficacy has obviously improved. With constant development of surgical technique and internal fixation system,this procedure offers a better life quality.
Objective To evaluate the safety profile of elongating intramedullary rods for lower extremity fractures in osteogenesis imperfect( OI) children to provide rationales for future application in China. Methods We systematically searched the electronic databases of Pub Med,Em Base,Cochrane library,Wanfang Data Resource System of Digital Periodicals and Chinese Journal Full text Database with the inception of January2018. All processes followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses( PRISMA). And inclusion and exclusion standards were implemented. The summary results were calculated by a random effect model. Results A total of 8 studies were included into the final cohort. There were 258 lower extremities using the elongating intramedullary rod approach. The mean age was 3. 1-8. 0 years and the follow-up period 17-228 months. The rate of rod-related complications was 25. 00%( 95% CI: 15. 00%-34. 00%) and most cases were related with rod migration( 13. 54%). Egger and Begg tests showed no significant publication bias( P_(Egger): 0. 248; P_(Begg): 0. 386). The rate of bone-related complications was 16. 00%( 95% CI: 9. 00%-23. 00%) and refractures were predominant( 8. 43%). However,Egger and Begg tests showed significant publication bias( P_(Egger): 0. 040; P_(Begg): 0. 086). The reoperative rate was 23. 00%( 95% CI: 12. 00%-35. 00%).And Egger and Begg tests also showed no significant publication bias( P_(Egger): 0. 734; P_(Begg): 0. 806). Conclusion During elongating intramedullary rod in OI surgery,rod migration and refracture remain two major postoperative complications. However,comparing with nonelongating intramedullary rodding,the efficacy has obviously improved. With constant development of surgical technique and internal fixation system,this procedure offers a better life quality.
引文
1 Forlino A,Marini JC.Osteogenesis imperfecta[J].Lancet.2016,387(10028):1657-1671.DOI:10.1016/S0140-6736(15)00728-X.
2潘少川.实用小儿骨科学[M].第3版:人民卫生出版社,2016,194-195.Pan SC.Practice of Pediatric Orthopedics[M].Third Edition:People's Medical Publishing Press,2016,194-195.
3 Sterian A,Balanescu R,Barbilian A,et al.Early telescopic rod osteosynthesis for Osteogenesis Imperfecta patients[J].JMed Life,2015,8(4):544-547.
4 Lang-Stevenson AI,Sharrard WJ.Intramedullary rodding with Bailey-Dubow extensible rods in osteogenesis imperfecta.An interim report of results and complications[J].J Bone Joint Surg Br,1984,66(2):227-232.
5 Wilkinson JM,Scott BW,Clarke AM,et al.Surgical stabilisation of the lower limb in osteogenesis imperfecta using the Sheffield Telescopic Intramedullary Rod System[J].J Bone Joint Surg Br,1998,80(6):999-1004.
6 Fassier F.Fassier-Duval Telescopic System:How I Do It?[J].J Pediatr Orthop,2017,37(6):S48-S51.DOI:10.1097/BPO.0000000000001024.
7 Cho TJ,Choi IH,Chung CY,et al.Interlocking telescopic rod for patients with osteogenesis imperfecta[J].J Bone Joint Surg Am,2007,89(5):1028-1035.DOI:10.2106/JBJS.F.00814.
8曾宪涛,庄丽萍,杨宗国,等.Meta分析系列之七:非随机试验性研究、诊断性试验及动物实验的质量评价工具[J].中国循证心血管医学杂志,2012,4(6):496-499.DOI:10.3969/j.1674-4055.2012.06.003.Zeng XT,Zhuang LP,Yang ZG,et al.The seventh article of the Meta analysis series:the quality evaluation tool of the non-randomized study,diagnostic study and animal experiment[J].Chin J Evid Based Cardiovase Med,2012,4(6):496-499.DOI:10.3969/j.1674-4055.2012.06.003.
9 Der Simonian R,Laird N.Meta-analysis in clinical trials[J].Control Clin Trials,1986,7:177-188.
10 Ades AE,Lu G,Higgins JP.The interpretation of randomeffects metaanalysis in decision models[J].Med Decis Making,2005,25:646-654.DOI:10.1177/0272989X05282643.
11 Deeks JJ,Higgins JPT,Altman DG.Analyzing data and undertaking meta-analyses.In:Higgins J,Green S,eds.Cochrane Handbook for Systematic Reviews of Interventions 5.0.1.Oxford,UK:The Cochrane Collaboration:2008;chap 9.
12 Higgins JP,Thompson SG,Deeks JJ,et al.Measuring inconsistency in meta-analyses[J].BMJ,2003,327(7414):557-560.DOI:10.1136/bmj.327.7414.557.
13 Tobias A.Assessing the influence of a single study in metaanalysis[J].Stata Tech Bull,1999,47:15-17.
14 Birke O,Davies N,Latimer M,et al.Experience with the Fassier-Duval telescopic rod:first 24 consecutive cases with a minimum of 1-year follow-up[J].J Pediatr Orthop,2011,31(4):458-464.DOI:10.1097/BPO.0b013e31821bfb50.
15 Lee RJ,Paloski MD,Sponseller PD,et al.Bent Telescopic Rods in Patients With Osteogenesis Imperfecta[J].J Pediatr Orthop,2016,36(6):656-660.DOI:10.1097/BPO.0000000000000509.
16 Stockley I,Bell MJ,Sharrard WJ.The role of expanding intramedullary rods in osteogenesis imperfecta[J].J Bone Joint Surg Br,1989,71(3):422-427.
17 El-Adl G,Khalil MA,Enan A,et al.Telescoping versus non-telescoping rods in the treatment of osteogenesis imperfecta[J].Acta Orthop Belg,2009,75(2):200-208.
18 Nicolaou N,Bowe JD,Wilkinson JM,et al.Use of the Sheffield telescopic intramedullary rod system for the management of osteogenesis imperfecta:clinical outcomes at an average follow-up of nineteen years[J].J Bone Joint Surg Am,2011,93(21):1994-2000.DOI:10.2106/JBJS.J.01893.
19 Rosemberg DL,Goiano EO,Akkari M,et al.Effects of a telescopic intramedullary rod for treating patients with osteogenesis imperfecta of the femur[J].J Child Orthop,2018,12(1):97-103.DOI:10.1302/1863-2548.12.170009.
20宿玉玺,赵仁欢,覃佳强,等.Rush钉矫治成骨不全儿童股骨畸形的疗效观察[J].第三军医大学学报,2015,37(3):238-242.DOI:10.16016/j.1000-5404.201409066.Su YX,Zhao RH,Qin JQ,et al.Clinical efficacy of Rush rods in correction of femoral deformity in children's tosteogenesis imperfecta[J].J Third Mil Med Univ,2015,37(3):238-242.DOI:10.16016/j.1000-5404.201409066.
21任秀智,曾裴,李冰,等.多段截骨矫形髓内固定治疗儿童成骨不全症[J].中华骨科杂志,2012,32(5):477-481.DOI:10.3760/cma.j.issn.0253-2352.2012.05.018.Ren XZ,Zeng P,Li B,et al.Multi-section osteotomy and intramedullary fixation for children with osteogenesis imperfecta[J].Chinese Journal of Orthopaedics,2012,32(5):477-481.DOI:10.3760/cma.j.issn.0253-2352.2012.05.018.
22 Joseph B,Rebello G,B CK.The choice of intramedullary devices for the femur and the tibia in osteogenesis imperfecta[J].J Pediatr Orthop B,2005,14(5):311-319.
23 Mulpuri K,Joseph B.Intramedullary rodding in osteogenesis imperfecta[J].J Pediatr Orthop,2000,20(2):267-273.
24 Boutaud B,Laville JM.Elastic sliding central medullary nailing with osteogenesis imperfecta.Fourteen cases at eight years follow-up[J].Rev Chir Orthop Reparatrice Appar Mot,2004,90(4):304-311.
25 Bailey RW,Dubow HI.Studies of longitudinal bone growth resulting in an extensible nail[J].Surg Forum,1963,14:455-458.
26 Luhmann SJ,Sheridan JJ,Capelli AM,et al.Management of lower-extremity deformities in osteogenesis imperfecta with extensible intramedullary rod technique:a 20-year experience[J].J Pediatr Orthop,1998,18(1):88-94.
27 Middleton RW.Closed intramedullary rodding for osteogenesis imperfecta[J].J Bone Joint Surg Br,1984,66(5):652-655.
28 Nicholas RW,James P.Telescoping intramedullary stabilization of the lower extremities for severe osteogenesis imperfecta[J].J Pediatr Orthop,1990,10(2):219-223.
29 Bailey RW.Further clinical experience with the extensible nail[J].Clin Orthop Relat Res,1981,(159):171-176.
30 Scollan JP,Jauregui JJ,Jacobsen CM,et al.The Outcomes of Nonelongating Intramedullary Fixation of the Lower Extremity for Pediatric Osteogenesis Imperfecta Patients:AMeta-analysis[J].J Pediatr Orthop,2017,37(5):e313-e316.DOI:10.1097/BPO.0000000000000970.
31 Cho TJ,Kim JB,Lee JW,et al.Fracture in long bones stabilised by telescopic intramedullary rods in patients with osteogenesis imperfecta[J].J Bone Joint Surg Br,2011,93(5):634-638.DOI:10.1302/0301-620X.93B5.25499.
32 Sterian A,Balanescu R,Barbilian A,et al.Osteosynthesis in Osteogenesis Imperfecta,telescopic versus non-telescopic nailing[J].J Med Life,2015,8(4):563-565.
33 Grossman LS,Price AL,Rush ET,et al.Initial Experience With Percutaneous IM Rodding of the Humeri in Children With Osteogenesis Imperfecta[J].J Pediatr Orthop,2018,38(9):484-489.DOI:10.1097/BPO.0000000000000856.
34 Azzam KA,Rush ET,Burke BR,et al.Mid-term Results of Femoral and Tibial Osteotomies and Fassier-Duval Nailing in Children With Osteogenesis Imperfecta[J].J Pediatr Orthop,2018,38(6):331-336.DOI:10.1097/BPO.0000000000000824.
35 Sa-Ngasoongsong P,Saisongcroh T,Angsanuntsukh C,et al.Using humeral nail for surgical reconstruction of femur in adolescents with osteogenesis imperfecta[J].World J Orthop,2017,8(9):735-740.DOI:10.5312/wjo.v8.i9.735.
2潘少川.实用小儿骨科学[M].第3版:人民卫生出版社,2016,194-195.Pan SC.Practice of Pediatric Orthopedics[M].Third Edition:People's Medical Publishing Press,2016,194-195.
3 Sterian A,Balanescu R,Barbilian A,et al.Early telescopic rod osteosynthesis for Osteogenesis Imperfecta patients[J].JMed Life,2015,8(4):544-547.
4 Lang-Stevenson AI,Sharrard WJ.Intramedullary rodding with Bailey-Dubow extensible rods in osteogenesis imperfecta.An interim report of results and complications[J].J Bone Joint Surg Br,1984,66(2):227-232.
5 Wilkinson JM,Scott BW,Clarke AM,et al.Surgical stabilisation of the lower limb in osteogenesis imperfecta using the Sheffield Telescopic Intramedullary Rod System[J].J Bone Joint Surg Br,1998,80(6):999-1004.
6 Fassier F.Fassier-Duval Telescopic System:How I Do It?[J].J Pediatr Orthop,2017,37(6):S48-S51.DOI:10.1097/BPO.0000000000001024.
7 Cho TJ,Choi IH,Chung CY,et al.Interlocking telescopic rod for patients with osteogenesis imperfecta[J].J Bone Joint Surg Am,2007,89(5):1028-1035.DOI:10.2106/JBJS.F.00814.
8曾宪涛,庄丽萍,杨宗国,等.Meta分析系列之七:非随机试验性研究、诊断性试验及动物实验的质量评价工具[J].中国循证心血管医学杂志,2012,4(6):496-499.DOI:10.3969/j.1674-4055.2012.06.003.Zeng XT,Zhuang LP,Yang ZG,et al.The seventh article of the Meta analysis series:the quality evaluation tool of the non-randomized study,diagnostic study and animal experiment[J].Chin J Evid Based Cardiovase Med,2012,4(6):496-499.DOI:10.3969/j.1674-4055.2012.06.003.
9 Der Simonian R,Laird N.Meta-analysis in clinical trials[J].Control Clin Trials,1986,7:177-188.
10 Ades AE,Lu G,Higgins JP.The interpretation of randomeffects metaanalysis in decision models[J].Med Decis Making,2005,25:646-654.DOI:10.1177/0272989X05282643.
11 Deeks JJ,Higgins JPT,Altman DG.Analyzing data and undertaking meta-analyses.In:Higgins J,Green S,eds.Cochrane Handbook for Systematic Reviews of Interventions 5.0.1.Oxford,UK:The Cochrane Collaboration:2008;chap 9.
12 Higgins JP,Thompson SG,Deeks JJ,et al.Measuring inconsistency in meta-analyses[J].BMJ,2003,327(7414):557-560.DOI:10.1136/bmj.327.7414.557.
13 Tobias A.Assessing the influence of a single study in metaanalysis[J].Stata Tech Bull,1999,47:15-17.
14 Birke O,Davies N,Latimer M,et al.Experience with the Fassier-Duval telescopic rod:first 24 consecutive cases with a minimum of 1-year follow-up[J].J Pediatr Orthop,2011,31(4):458-464.DOI:10.1097/BPO.0b013e31821bfb50.
15 Lee RJ,Paloski MD,Sponseller PD,et al.Bent Telescopic Rods in Patients With Osteogenesis Imperfecta[J].J Pediatr Orthop,2016,36(6):656-660.DOI:10.1097/BPO.0000000000000509.
16 Stockley I,Bell MJ,Sharrard WJ.The role of expanding intramedullary rods in osteogenesis imperfecta[J].J Bone Joint Surg Br,1989,71(3):422-427.
17 El-Adl G,Khalil MA,Enan A,et al.Telescoping versus non-telescoping rods in the treatment of osteogenesis imperfecta[J].Acta Orthop Belg,2009,75(2):200-208.
18 Nicolaou N,Bowe JD,Wilkinson JM,et al.Use of the Sheffield telescopic intramedullary rod system for the management of osteogenesis imperfecta:clinical outcomes at an average follow-up of nineteen years[J].J Bone Joint Surg Am,2011,93(21):1994-2000.DOI:10.2106/JBJS.J.01893.
19 Rosemberg DL,Goiano EO,Akkari M,et al.Effects of a telescopic intramedullary rod for treating patients with osteogenesis imperfecta of the femur[J].J Child Orthop,2018,12(1):97-103.DOI:10.1302/1863-2548.12.170009.
20宿玉玺,赵仁欢,覃佳强,等.Rush钉矫治成骨不全儿童股骨畸形的疗效观察[J].第三军医大学学报,2015,37(3):238-242.DOI:10.16016/j.1000-5404.201409066.Su YX,Zhao RH,Qin JQ,et al.Clinical efficacy of Rush rods in correction of femoral deformity in children's tosteogenesis imperfecta[J].J Third Mil Med Univ,2015,37(3):238-242.DOI:10.16016/j.1000-5404.201409066.
21任秀智,曾裴,李冰,等.多段截骨矫形髓内固定治疗儿童成骨不全症[J].中华骨科杂志,2012,32(5):477-481.DOI:10.3760/cma.j.issn.0253-2352.2012.05.018.Ren XZ,Zeng P,Li B,et al.Multi-section osteotomy and intramedullary fixation for children with osteogenesis imperfecta[J].Chinese Journal of Orthopaedics,2012,32(5):477-481.DOI:10.3760/cma.j.issn.0253-2352.2012.05.018.
22 Joseph B,Rebello G,B CK.The choice of intramedullary devices for the femur and the tibia in osteogenesis imperfecta[J].J Pediatr Orthop B,2005,14(5):311-319.
23 Mulpuri K,Joseph B.Intramedullary rodding in osteogenesis imperfecta[J].J Pediatr Orthop,2000,20(2):267-273.
24 Boutaud B,Laville JM.Elastic sliding central medullary nailing with osteogenesis imperfecta.Fourteen cases at eight years follow-up[J].Rev Chir Orthop Reparatrice Appar Mot,2004,90(4):304-311.
25 Bailey RW,Dubow HI.Studies of longitudinal bone growth resulting in an extensible nail[J].Surg Forum,1963,14:455-458.
26 Luhmann SJ,Sheridan JJ,Capelli AM,et al.Management of lower-extremity deformities in osteogenesis imperfecta with extensible intramedullary rod technique:a 20-year experience[J].J Pediatr Orthop,1998,18(1):88-94.
27 Middleton RW.Closed intramedullary rodding for osteogenesis imperfecta[J].J Bone Joint Surg Br,1984,66(5):652-655.
28 Nicholas RW,James P.Telescoping intramedullary stabilization of the lower extremities for severe osteogenesis imperfecta[J].J Pediatr Orthop,1990,10(2):219-223.
29 Bailey RW.Further clinical experience with the extensible nail[J].Clin Orthop Relat Res,1981,(159):171-176.
30 Scollan JP,Jauregui JJ,Jacobsen CM,et al.The Outcomes of Nonelongating Intramedullary Fixation of the Lower Extremity for Pediatric Osteogenesis Imperfecta Patients:AMeta-analysis[J].J Pediatr Orthop,2017,37(5):e313-e316.DOI:10.1097/BPO.0000000000000970.
31 Cho TJ,Kim JB,Lee JW,et al.Fracture in long bones stabilised by telescopic intramedullary rods in patients with osteogenesis imperfecta[J].J Bone Joint Surg Br,2011,93(5):634-638.DOI:10.1302/0301-620X.93B5.25499.
32 Sterian A,Balanescu R,Barbilian A,et al.Osteosynthesis in Osteogenesis Imperfecta,telescopic versus non-telescopic nailing[J].J Med Life,2015,8(4):563-565.
33 Grossman LS,Price AL,Rush ET,et al.Initial Experience With Percutaneous IM Rodding of the Humeri in Children With Osteogenesis Imperfecta[J].J Pediatr Orthop,2018,38(9):484-489.DOI:10.1097/BPO.0000000000000856.
34 Azzam KA,Rush ET,Burke BR,et al.Mid-term Results of Femoral and Tibial Osteotomies and Fassier-Duval Nailing in Children With Osteogenesis Imperfecta[J].J Pediatr Orthop,2018,38(6):331-336.DOI:10.1097/BPO.0000000000000824.
35 Sa-Ngasoongsong P,Saisongcroh T,Angsanuntsukh C,et al.Using humeral nail for surgical reconstruction of femur in adolescents with osteogenesis imperfecta[J].World J Orthop,2017,8(9):735-740.DOI:10.5312/wjo.v8.i9.735.