摘要
目的比较钢板和髓内钉2种手术方式治疗成人肱骨骨折骨不连的效果。方法检索中国知网、万方、维普、中国生物医学文献数据库、PubMed数据库、Embase数据库和Cochrane Library中有关钢板和髓内钉治疗成人肱骨骨折骨不连的文献。时限为各库建库至2023年2月7日,通过文献筛选、质量评价、提取数据后,运用RevMan 5.4.1软件进行meta分析。结果共纳入10项临床对照研究,共668例患者,其中用钢板进行治疗的患者为336例,用髓内钉进行治疗的患者为332例。Meta分析结果表明,运用髓内钉治疗肱骨骨折骨不连在术中出血量(MD=5.51,95%CI 3.17~7.85,P<0.00001)、骨折时间愈合(MD=32.22,95%CI 11.32~53.12,P=0.003)、术后并发症(MD=2.96,95%CI 1.71~5.12,P=0.0001)、术后感染(OR=4.10,95%CI 1.84~9.13,P=0.0005)优于运用钢板治疗,差异有统计学意义;而在手术时间、术后桡神经损伤、术后关节活动受限及术后再次骨折方面,两组之间比较差异无统计学意义。结论在临床实践中,髓内钉内固定治疗成人肱骨骨折骨不连比钢板治疗治疗成人肱骨骨折骨不连具有一定的优势,但仍需要更多的临床试验数据提供更充分的证据。
Objective To compare the effects between steel plate and intramedullary nail in treating adult humeral fracture nonunion.Methods The literatures on the treatment of adult humeral fractures nonunion by using steel plates and intramedullary nails were retrieved from CNKI,Wanfang,VIP,Chinese Biomedical Literature Database,Pubmed Database,Embase Database,and Cochrane Library.The time limit was from the establishment of each database to February 7,2023.After literature screening,quality evaluation and data extraction,the meta analysis was conducted by using RevMan 5.4.1 software.Results A total of 10 clinical controlled studies were included,with a total of 668 patients.Among them,336 patients were treated with steel plates and 332 patients were treated with intramedullary nails.The meta analysis results showed that the use of intramedullary nail in the treatment of humeral fracture nonunion was superior to the use of steel plate in the treatment of humeral fracture nonunion in terms of intraoperative bleeding(MD=5.51,95%CI 3.17-7.85,P<0.000 01),fracture healing time(MD=32.22,95%CI 11.32-53.12,P=0.003),postoperative complications(MD=2.96,95%CI 1.71-5.12,P=0.000 1)and postoperative infection(OR=4.10,95%CI 1.84-9.13,P=0.000 5),and the differences were statistically significant.However,there was no statistical difference in terms of operation time,postoperative radial nerve injury,postoperative joint movement limitation and postoperative re-fracture between the two groups.Conclusion In clinical practice,the intramedullary nail fixation has certain advantages over steel plate in treating adult humeral fracture nonunion,but more clinical trial data are still needed to provide more sufficient evidences.
作者
李奥赢
詹万达
董辉
孙浩
LI Aoying;ZHAN Wanda;DONG Hui;SUN Hao(Department of Orthopedics,Yangzhou School of Clinical Medicine,Dalian Medical University,Yangzhou,Jiangsu 225001,China;Department of Orthopedics,Clinical Medical College,Yangzhou University,Yangzhou,Jiangsu 225001,China;Department of Orthopedics,Northern Jiangsu People's Hospital,Yangzhou,Jiangsu 225001,China)
出处
《现代医药卫生》
2024年第1期94-99,106,共7页
Journal of Modern Medicine & Health
基金
江苏省扬州市重点研发计划(社会发展)项目(YZ2023124)
苏北人民医院院级课题(yzucms202023)。
关键词
钢板
髓内钉
内固定
肱骨骨折
骨不连
META分析
Steel plate
Intramedullary nail
Internal fixation
Humeral fracture
Bone nonunion
Meta analysis
