髓內釘固定與加壓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》

作者：

李斌 ¹ , 白靖平 ² , 吳泰相 ³

1.新疆醫科大學醫學院（烏魯木齊 830054） 2. 新疆醫科大學附屬腫瘤醫院（烏魯木齊 830011） 3. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

肱骨干骨折骨折固定術髓內釘加壓鋼板隨機對照試驗系統評價

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目的　系統評價髓內釘固定與加壓鋼板內固定比較治療成人肱骨干骨折的療效及不良反應。
方法　計算機檢索Cochrane圖書館（2006年第1期）、MEDLINE（1966～2006）、EMBASE（1980～2006）、NRR（http://www.update-software.com/National/）、CCT（http://www.controlled-trials.com）和中國生物醫學文獻數據庫（CBM）。手工檢索6種中文主要骨科雜志。收集髓內釘固定與加壓鋼板內固定比較治療成人肱骨干骨折的隨機對照試驗，并評價納入研究的方法學質量。統計軟件采用Cochrane協作網提供的RevMan 4.2.8。
結果　共納入隨機對照試驗3篇，共215例患者，方法學質量均為B級。Meta分析結果表明，髓內釘與鋼板比較，前者固定術后二次手術率較高[OR=2.68，95%CI（1.19，6.04），P=0.02 ]，且術后肩部疼痛及肩關節活動范圍減少明顯[OR=13.02，95%CI（2.23，75.95），P=0.004；OR=18.60，95%CI（1.01，341.83），P=0.05]；在骨折不愈合率、醫源性橈神經損傷率及感染率上，兩者差異無統計學意義。而骨折愈合時間因文獻未提供詳細數據未能做Meta分析。
結論　與鋼板內固定相比，髓內釘固定治療成人肱骨干骨折的二次手術率更高，造成肩部疼痛及肩關節活動障礙更明顯。而在骨折不愈合率、醫源性橈神經損傷率及感染率上，兩組差異無統計學意義。因本系統評價納入的病例數較少，尚需更多設計嚴格的大樣本隨機對照研究來增加證據的強度。

引用本文： 李斌,白靖平,吳泰相. 髓內釘固定與加壓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, 06(10): 705-711. doi: 復制

1.	倪東亮,祝云利,林平.鋼板及交鎖髓內釘治療肱骨干骨折療效對比.中國矯形外科雜志, 2000; 7(12): 1 167–1 169.
2.	Zagorski JB, Latta LL, Zych GA, et al.Diaphyseal fractures of the humerus. Treatment with prefabricated braces. J Bone Joint Surg Am, 1988; 70(4): 607–610.
3.	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.
4.	Christensen NO.Kuntscher intramedullary reaming and nail fixation for nonunion of the humerus. Clin Orthop Relat Res, 1976; (116): 222–225.
5.	Vander Griend R, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am, 1986; 68(3): 430–433.
6.	Modabber MR, Jupiter JB. Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res, 1998; (347): 93–104.
7.	DeLong WG Jr, Born CT, Marcelli E, et al. Ender nail fixation in long bone fractures: experience in a level I trauma center. J Trauma, 1989; 29(5): 571–576.
8.	Durbin RA, Gottesman MJ, Saunders KC. Hackethal stacked nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res, 1983; (179): 168–174.
9.	Hall RF Jr, Pankovich AM. Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am, 1987; 69(4): 558–567.
10.	Chiu FY, Chen CM, Lin CF, et al. Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma, 1997; 43(6): 947–951.
11.	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.
12.	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, randomised trial. J Bone Joint Surg Br, 2000; 82(3):336–369.
13.	Henley MB, Chapman JR, Claudi BF. Closed retrograde Hackethal nail stabilization of humeral shaft fractures. J Orthop Trauma, 1992; 6(1): 18–24.
14.	Ruedi T, Moshfegh A, Pfeiffer KM, et al. Fresh fractures of the shaft of the humerus--conservative or operative treatment? Reconstr Surg Traumatol. 1974; 14(0): 65–74.
15.	Chacha PB. Compression plating without bone grafts for delayed and non-union of humeral shaft fractures. Injury, 1974; 5(4): 283–290.
16.	Naiman PT, Schein AJ, Siffert RS. Use of ASIF compression plates in selected shaft fractures of the upper extremity: a preliminary report. Clin Orthop, 1970; 71: 208.
17.	Ni DL,Zhu XL,Ling P. The Comparision between the Effect of Plate and Locked Intramedullary Nailing in the Fracture of Humeral Fracture. The Orthopedic Journal of China, 2000; 7(12): 1 167–1 169.

1. 倪東亮,祝云利,林平.鋼板及交鎖髓內釘治療肱骨干骨折療效對比.中國矯形外科雜志, 2000; 7(12): 1 167–1 169.
2. Zagorski JB, Latta LL, Zych GA, et al.Diaphyseal fractures of the humerus. Treatment with prefabricated braces. J Bone Joint Surg Am, 1988; 70(4): 607–610.
3. 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.
4. Christensen NO.Kuntscher intramedullary reaming and nail fixation for nonunion of the humerus. Clin Orthop Relat Res, 1976; (116): 222–225.
5. Vander Griend R, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am, 1986; 68(3): 430–433.
6. Modabber MR, Jupiter JB. Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res, 1998; (347): 93–104.
7. DeLong WG Jr, Born CT, Marcelli E, et al. Ender nail fixation in long bone fractures: experience in a level I trauma center. J Trauma, 1989; 29(5): 571–576.
8. Durbin RA, Gottesman MJ, Saunders KC. Hackethal stacked nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res, 1983; (179): 168–174.
9. Hall RF Jr, Pankovich AM. Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am, 1987; 69(4): 558–567.
10. Chiu FY, Chen CM, Lin CF, et al. Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma, 1997; 43(6): 947–951.
11. 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.
12. 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, randomised trial. J Bone Joint Surg Br, 2000; 82(3):336–369.
13. Henley MB, Chapman JR, Claudi BF. Closed retrograde Hackethal nail stabilization of humeral shaft fractures. J Orthop Trauma, 1992; 6(1): 18–24.
14. Ruedi T, Moshfegh A, Pfeiffer KM, et al. Fresh fractures of the shaft of the humerus--conservative or operative treatment? Reconstr Surg Traumatol. 1974; 14(0): 65–74.
15. Chacha PB. Compression plating without bone grafts for delayed and non-union of humeral shaft fractures. Injury, 1974; 5(4): 283–290.
16. Naiman PT, Schein AJ, Siffert RS. Use of ASIF compression plates in selected shaft fractures of the upper extremity: a preliminary report. Clin Orthop, 1970; 71: 208.
17. Ni DL,Zhu XL,Ling P. The Comparision between the Effect of Plate and Locked Intramedullary Nailing in the Fracture of Humeral Fracture. The Orthopedic Journal of China, 2000; 7(12): 1 167–1 169.

《中國循證醫學雜志》

髓內釘固定與加壓鋼板內固定比較治療成人肱骨干骨折的系統評價

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《中國循證醫學雜志》

髓內釘固定與加壓鋼板內固定比較治療成人肱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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