擴髓與非擴髓髓內釘固定治療股骨干骨折的系統評價_《中國循證醫學雜志》

作者：

廖燚 ¹ , 王新玲 ² , 吳泰相 ³

1. 新疆克拉瑪依市中心醫院骨科,克拉瑪依,8340002. 新疆克拉瑪依市中心醫院核醫學科3. 四川大學華西醫院中國循證醫學中心/臨床流行病學資源與培訓中心(成都),成都,610041;

關鍵詞：

股骨干骨折擴髓插釘術非擴髓插釘術骨折固定術,髓內系統評價

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目的　對擴髓與非擴髓髓內釘固定治療股骨干骨折的療效進行系統評價.
方法　計算機檢索MEDLINE(1966～2004.5)、EMBASE(1966～2004.5)、Cochrane圖書館(2004年第2期)、Cochrane協作網肌骨創傷組試驗數據庫(2004.5)和中國生物醫學文獻數據庫(1979～2004.5),手工檢索 lt;中華骨科雜志 gt;(創刊～2004.5)和 lt;中華創傷骨科雜志 gt;(創刊～2004.5),收集所有相關隨機對照試驗及半隨機對照試驗,并采用RevMan 4.2.3進行Meta分析.
結果　共納入5個隨機對照試驗,2個半隨機對照試驗.Meta分析顯示,與非擴髓髓內釘固定相比,擴髓髓內釘固定能降低股骨干骨折的不愈合率[RR=0.38,95%CI(0.17,0.83),P=0.01]和內固定失效率[RR=0.42,95%CI(0.20,0.89),P=0.02].
結論　與非擴髓髓內釘固定相比,擴髓髓內釘固定能降低股骨干骨折的不愈合率及內固定失效率.但擴髓與否與肺部并發癥、骨折愈合時間、感染、畸形愈合的發生及手術時間、失血量等的關系,以及骨折開放與否、是否合并多發傷、及骨折的部位等對上述指標的影響有待于進一步研究.

引用本文： 廖燚,王新玲,吳泰相. 擴髓與非擴髓髓內釘固定治療股骨干骨折的系統評價. 中國循證醫學雜志, 2004, 04(9): 620-626. doi: 復制

1.	［1］Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed[J]. J Am Acad Orthop Surg, 2000; 8(2): 83-90.
2.	［2］Debrauwer S, Hendrix K, Verdonk R. Anterograde femoral nailing with a reamed interlocking titanium alloy nail[J]. Acta Orthop Belg, 2000; 66(5): 484-489.
3.	［3］Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures[J]. J Orthop trauma, 2001; 15(1): 28-32.
4.	［4］Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003][M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, Issue 1.
5.	［5］Anonymous. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial[J]. J Bone Joint Surg Am, 2003; 85(11): 2 093-2 096.
6.	［6］Tornetta P 3rd, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing[J]. J Orthop Trauma, 2000; 14(1): 15-19.
7.	［7］Clatworthy MG, Clark DI, Gray DH, Hardy AE. Reamed versus unreamed femoral nails. A randomised, prospective trial[J]. J Bone Joint Surg Br, 1998; 80(3): 485-489.
8.	［8］Powell J, DeGroote R, Buckley R, Feibel R, Leighton R, McCormack R, McKee M, Schemitsch EH. A prospective randomised clinical trial comparing reamed vs unreamed intramedullary nailing of femoral shaft fractures: an assessment of pulmonary dysfunction[J]. J Bone Joint Surg Br, 2000; 82 (Suppl 2): 148-149.
9.	［9］Bone LB, Kowalski J, Rohrbacher B, Stegemann P. Reamed versus unreamed femoral nailing: a prospective randomized study[C]. Presented at the 12th Annual Meeting of the Orthopaedic Trauma Association, Boston, Massachusetts, 1996.
10.	［10］Selvakumar K, Saw KY, Fathima M. Comparison study between reamed and unreamed nailing of closed femoral fractures[J]. Med J Malaysia, 2001; 56 Suppl D: 24-28.
11.	［11］Tuzuner T, Subasi M, Kapukaya A, Necmioglu NS. Treatment of femoral shaft fractures with interlocking intramedullary nailing[J]. Acta Orthop Traumatol Turc, 2002; 36(3): 211-219.
12.	［12］Arazi M, Ogun TC, Oktar MN, Memik R, Kutlu A. Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure[J]? J Trauma, 2001; 50(4): 711-716.
13.	［13］Reichert ILH, McCarthy ID, Hughes SPF. The acute vascular response to intramedullary nailing: microsphere estimation of blood flow in the intact ovine tibia[J]. J Bone Joint Surg Br, 1995; 77-B(3): 490-493.
14.	［14］Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SG. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis[J]. J Orthop Trauma, 2000; 14(1): 2-9.
15.	［15］Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail[J]. J Bone Joint Surg Am, 1999; 81(11): 1 538-1 544.
16.	［16］Hulth A. Current concepts of fracture healing[J]. Clin Orthop, 1989; (249): 265-284.
17.	［17］Zhang YM, Liang GH, Feng GP, Chen ZY. The effect of reaming on intramedullary pressure and pulmonary fat embolization[J]. Chin J Orthop, 1999; 19(8): 494-497.
18.	張毅敏, 梁國穗, 馮國培, 陳振宇. 擴髓對髓內壓和肺部脂肪栓塞的影響[J]. 中華骨科雜志, 1999; 19(8): 494～497.
19.	［18］Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing demonstrated by intraoperative echocardiography[J]. Injury, 1993; 24 (Suppl 3): 73-81.
20.	［19］Pape H, Regel G, Dwenger A, Sturm J, Tscherne H. Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients[J]. Injury, 1993; 24 (Suppl 3): 82-103.
21.	［20］Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma[J]. J Trauma, 1993; 35(5): 709-716.
22.	［21］Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R. Transcardiac echocardiography during invasive intramedullary procedures[J]. J Bone Joint Surg Br, 1995; 77(3): 450-455.
23.	［22］Charash WE, Fabian TC, Croce M. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma[J]. J Trauma, 1994; 37(4): 667-672.
24.	［23］Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilisation of fractures: a prospective randomized study[J]. J Bone Joint Surg Am, 1989; 71(3): 336-340.
25.	［24］Helttula I, Karanko M, Gullichsen E. Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures[J]. J Trauma, 2000; 48(4): 704-710.
26.	［25］Liu SJ, Li FB, Chen LY, Pan T, Peng XS. The influence of reamed and unreamed femoral intramedullary nailing on function of pulmonary gas exchange[J]. Orthop J Chin, 2003; 11(1): 27-29.
27.	劉世敬, 李佛保, 陳立言, 潘滔, 彭新生. 股骨干骨折擴髓與不擴髓固定對肺氣體交換功能的影響[J]. 中國矯形外科雜志, 2003; 11(1): 27～29.

1. ［1］Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed[J]. J Am Acad Orthop Surg, 2000; 8(2): 83-90.
2. ［2］Debrauwer S, Hendrix K, Verdonk R. Anterograde femoral nailing with a reamed interlocking titanium alloy nail[J]. Acta Orthop Belg, 2000; 66(5): 484-489.
3. ［3］Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures[J]. J Orthop trauma, 2001; 15(1): 28-32.
4. ［4］Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003][M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, Issue 1.
5. ［5］Anonymous. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial[J]. J Bone Joint Surg Am, 2003; 85(11): 2 093-2 096.
6. ［6］Tornetta P 3rd, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing[J]. J Orthop Trauma, 2000; 14(1): 15-19.
7. ［7］Clatworthy MG, Clark DI, Gray DH, Hardy AE. Reamed versus unreamed femoral nails. A randomised, prospective trial[J]. J Bone Joint Surg Br, 1998; 80(3): 485-489.
8. ［8］Powell J, DeGroote R, Buckley R, Feibel R, Leighton R, McCormack R, McKee M, Schemitsch EH. A prospective randomised clinical trial comparing reamed vs unreamed intramedullary nailing of femoral shaft fractures: an assessment of pulmonary dysfunction[J]. J Bone Joint Surg Br, 2000; 82 (Suppl 2): 148-149.
9. ［9］Bone LB, Kowalski J, Rohrbacher B, Stegemann P. Reamed versus unreamed femoral nailing: a prospective randomized study[C]. Presented at the 12th Annual Meeting of the Orthopaedic Trauma Association, Boston, Massachusetts, 1996.
10. ［10］Selvakumar K, Saw KY, Fathima M. Comparison study between reamed and unreamed nailing of closed femoral fractures[J]. Med J Malaysia, 2001; 56 Suppl D: 24-28.
11. ［11］Tuzuner T, Subasi M, Kapukaya A, Necmioglu NS. Treatment of femoral shaft fractures with interlocking intramedullary nailing[J]. Acta Orthop Traumatol Turc, 2002; 36(3): 211-219.
12. ［12］Arazi M, Ogun TC, Oktar MN, Memik R, Kutlu A. Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure[J]? J Trauma, 2001; 50(4): 711-716.
13. ［13］Reichert ILH, McCarthy ID, Hughes SPF. The acute vascular response to intramedullary nailing: microsphere estimation of blood flow in the intact ovine tibia[J]. J Bone Joint Surg Br, 1995; 77-B(3): 490-493.
14. ［14］Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SG. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis[J]. J Orthop Trauma, 2000; 14(1): 2-9.
15. ［15］Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail[J]. J Bone Joint Surg Am, 1999; 81(11): 1 538-1 544.
16. ［16］Hulth A. Current concepts of fracture healing[J]. Clin Orthop, 1989; (249): 265-284.
17. ［17］Zhang YM, Liang GH, Feng GP, Chen ZY. The effect of reaming on intramedullary pressure and pulmonary fat embolization[J]. Chin J Orthop, 1999; 19(8): 494-497.
18. 張毅敏, 梁國穗, 馮國培, 陳振宇. 擴髓對髓內壓和肺部脂肪栓塞的影響[J]. 中華骨科雜志, 1999; 19(8): 494～497.
19. ［18］Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing demonstrated by intraoperative echocardiography[J]. Injury, 1993; 24 (Suppl 3): 73-81.
20. ［19］Pape H, Regel G, Dwenger A, Sturm J, Tscherne H. Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients[J]. Injury, 1993; 24 (Suppl 3): 82-103.
21. ［20］Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma[J]. J Trauma, 1993; 35(5): 709-716.
22. ［21］Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R. Transcardiac echocardiography during invasive intramedullary procedures[J]. J Bone Joint Surg Br, 1995; 77(3): 450-455.
23. ［22］Charash WE, Fabian TC, Croce M. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma[J]. J Trauma, 1994; 37(4): 667-672.
24. ［23］Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilisation of fractures: a prospective randomized study[J]. J Bone Joint Surg Am, 1989; 71(3): 336-340.
25. ［24］Helttula I, Karanko M, Gullichsen E. Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures[J]. J Trauma, 2000; 48(4): 704-710.
26. ［25］Liu SJ, Li FB, Chen LY, Pan T, Peng XS. The influence of reamed and unreamed femoral intramedullary nailing on function of pulmonary gas exchange[J]. Orthop J Chin, 2003; 11(1): 27-29.
27. 劉世敬, 李佛保, 陳立言, 潘滔, 彭新生. 股骨干骨折擴髓與不擴髓固定對肺氣體交換功能的影響[J]. 中國矯形外科雜志, 2003; 11(1): 27～29.

《中國循證醫學雜志》

擴髓與非擴髓髓內釘固定治療股骨干骨折的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國循證醫學雜志》

擴髓與非擴髓髓內釘固定治療股骨干骨折的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料