鋼板內固定和髓內針固定比較治療成人肱骨干骨折療效的系統評價_《中國循證醫學雜志》

作者：

李連華 ,  孫天勝 , 劉智 , 郭永智 , 李紹光 , 秦聰聰

全軍骨科研究所北京軍區總醫院骨科（北京?100700）;

關鍵詞：

肱骨干骨折骨折內固定髓內針鋼板隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20080149

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目的　系統評價鋼板內固定與髓內針固定治療成人肱骨干骨折的療效。
方法　計算機檢索PubMed（1950～2007.9）、OVID MEDLINE（1950～2007.9）、OVID CINAHL（1950～2007.9）、OVID EBM（2007年第3季度）、CBMdisc（1978～2007.6），CNKI（1981～2007.6），手工檢索《中華外科雜志》等6種中文主要外科雜志。收集鋼板內固定與髓內針固定比較治療成人肱骨干骨折的隨機對照試驗（RCT），評價納入研究的方法學質量，并提取有效數據采用Stata 10.0軟件進行Meta分析。
結果　共納入6個RCT，共425例患者。文獻異質性較小（P gt;0.1）。累積Meta分析結果表明，鋼板內固定與髓內針固定比較，在再次手術發生率上，2000年以前（包括2000年）Meta分析結果為鋼板內固定可顯著降低再次手術發生率［OR=0.39，95%CI（0.17，0.90），P=0.03］，但2000年以后至今，兩者再次手術發生率的差異無統計學差異［OR=0.54，95%CI（0.27，1.08），P=0.08］；在肩部撞擊發生率上，鋼板內固定顯著低于髓內針固定［OR=0.13，95%CI（0.03，0.65），P=0.01］。在術后再次手術率、骨折不愈合率、醫源性神經損傷、深部感染、內固定失敗等方面，兩者差異無統計學意義。對于術后骨折愈合時間、手術時間、出血（輸血）量上，由于文獻未提供詳細數據，未能做Meta分析，只是進行描述性分析。
結論　與鋼板內固定相比較，髓內針固定治療成人肱骨干骨折容易導致肩部撞擊的發生。在再次手術發生率、骨折不愈合率、醫源性神經損傷、深部感染、內固定失敗等方面，兩者差異無統計學意義。因本次系統評價納入病例數較少，尚需要更多設計嚴謹的大樣本隨機對照研究來增加證據的論證強度。

引用本文： 李連華,孫天勝,劉智,郭永智,李紹光,秦聰聰. 鋼板內固定和髓內針固定比較治療成人肱骨干骨折療效的系統評價. 中國循證醫學雜志, 2008, 08(8): 662-667. doi: 10.7507/1672-2531.20080149 復制

1.	Pollock AH, Drake D, Bovill EG. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg (Am), 1981, 63(2): 239-243.
2.	Bell MJ, Beauchamp CG, Kellam JK, et al. The results of plating humeral shaft fractures in patients with multiple injuries: the Sunnybrook experience. J Bone Joint Surg (Br), 1985, 67(2): 293-296.
3.	Brumback RJ, Bosse MJ, Poka A, et al. Intramedullary stabilisation of humerus shaft fractures in patients with multiple trauma. J Bone Joint Surg (Am), 1986, 68(7): 960-970.
4.	Amillo S, Barrios RH, Martinez-Peric R. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma, 1993, 7(3): 211-215.
5.	Foster RJ, Swiontkowski MF, Bach AW. Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg, 1993, 18A(1): 121-124.
6.	Robinson CM, Bell KM, Court-Brown CM, et al. Locked nailing of humeral shaft fractures. J Bone Joint Surg (Br), 1992, 74(4): 558-562.
7.	Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
8.	Breslow NE, Day DE. Combination of results from a series of 2 x 2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
9.	Bhandari M, Devereaux PJ, McKee MD, et al. Compression plating versus intramedullary nailing of humeral shaft fractures—a meta-analysis. Acta Orthop, 2006, 77(2): 279-284.
10.	李斌, 白靖平, 吳泰相. 髓內針固定與鋼板內固定比較治療成人肱骨干骨折的系統評價. 中國循證醫學雜志, 2006, 6(10): 705-711.
11.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
12.	Kesemenli CC, Subasi M, Arslan H, et al. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc, 2003, 37(2): 120-125.
13.	Meekers FS, Broos PL. Operative treatment of humeral shaft fractures. The Leuven experience. Acta Orthop Belg, 2002, 68(5): 462-470.
14.	Lin J. Treatment of Humeral Shaft Fractures with Humeral Locked Nail and Comparison with Plate Fixation. J Trauma, 1998, 44(5): 859-864.
15.	Flinkkila T, Hyvonen P, Siira P, et al. Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg, 2004, 124(8): 537-541.
16.	Chao TC, Chou WY, Chung JC, et al. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop, 2005, 29(2): 88-91.
17.	Rodrigues-Merchan EC. Compression plating versus hackethal nailing in closed humeral shaft fractures failing nonoperative reduction. J Orthop Trauma, 1995, 9(3): 194-197.
18.	Chiu FY, Chen CM, Lin CF, et al. Closed Humeral Shaft Fractures: A Prospective Evaluation of Surgical Treatment. Journal of Trauma-Injury Infection & Critical Care, 1997, 43(6): 947-951.
19.	Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation: Intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3): 162-166.
20.	McCormack RG, Brien D, Buckley RE, et al. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective randomized trial. J Bone Joint Surg (Br), 2000, 82(7): 336-339.
21.	Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop, 2007, 31(3): 391-395.
22.	Daglar B, Delialioglu OM, Tasbas BA, et al. Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures. Acta Orthop Traumatol Turc, 2007, 41(1): 7-14.

1. Pollock AH, Drake D, Bovill EG. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg (Am), 1981, 63(2): 239-243.
2. Bell MJ, Beauchamp CG, Kellam JK, et al. The results of plating humeral shaft fractures in patients with multiple injuries: the Sunnybrook experience. J Bone Joint Surg (Br), 1985, 67(2): 293-296.
3. Brumback RJ, Bosse MJ, Poka A, et al. Intramedullary stabilisation of humerus shaft fractures in patients with multiple trauma. J Bone Joint Surg (Am), 1986, 68(7): 960-970.
4. Amillo S, Barrios RH, Martinez-Peric R. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma, 1993, 7(3): 211-215.
5. Foster RJ, Swiontkowski MF, Bach AW. Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg, 1993, 18A(1): 121-124.
6. Robinson CM, Bell KM, Court-Brown CM, et al. Locked nailing of humeral shaft fractures. J Bone Joint Surg (Br), 1992, 74(4): 558-562.
7. Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
8. Breslow NE, Day DE. Combination of results from a series of 2 x 2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
9. Bhandari M, Devereaux PJ, McKee MD, et al. Compression plating versus intramedullary nailing of humeral shaft fractures—a meta-analysis. Acta Orthop, 2006, 77(2): 279-284.
10. 李斌, 白靖平, 吳泰相. 髓內針固定與鋼板內固定比較治療成人肱骨干骨折的系統評價. 中國循證醫學雜志, 2006, 6(10): 705-711.
11. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
12. Kesemenli CC, Subasi M, Arslan H, et al. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc, 2003, 37(2): 120-125.
13. Meekers FS, Broos PL. Operative treatment of humeral shaft fractures. The Leuven experience. Acta Orthop Belg, 2002, 68(5): 462-470.
14. Lin J. Treatment of Humeral Shaft Fractures with Humeral Locked Nail and Comparison with Plate Fixation. J Trauma, 1998, 44(5): 859-864.
15. Flinkkila T, Hyvonen P, Siira P, et al. Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg, 2004, 124(8): 537-541.
16. Chao TC, Chou WY, Chung JC, et al. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop, 2005, 29(2): 88-91.
17. Rodrigues-Merchan EC. Compression plating versus hackethal nailing in closed humeral shaft fractures failing nonoperative reduction. J Orthop Trauma, 1995, 9(3): 194-197.
18. Chiu FY, Chen CM, Lin CF, et al. Closed Humeral Shaft Fractures: A Prospective Evaluation of Surgical Treatment. Journal of Trauma-Injury Infection & Critical Care, 1997, 43(6): 947-951.
19. Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation: Intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3): 162-166.
20. McCormack RG, Brien D, Buckley RE, et al. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective randomized trial. J Bone Joint Surg (Br), 2000, 82(7): 336-339.
21. Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop, 2007, 31(3): 391-395.
22. Daglar B, Delialioglu OM, Tasbas BA, et al. Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures. Acta Orthop Traumatol Turc, 2007, 41(1): 7-14.

《中國循證醫學雜志》

鋼板內固定和髓內針固定比較治療成人肱骨干骨折療效的系統評價

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《中國循證醫學雜志》

鋼板內固定和髓內針固定比較治療成人肱骨干骨折療效的系統評價

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