钢板内固定和髓内针固定比较治疗成人肱骨干骨折疗效的系统评价_《中国循证医学杂志》

作者：

李连华 ,  孙天胜 , 刘智 , 郭永智 , 李绍光 , 秦聪聪

全军骨科研究所北京军区总医院骨科（北京?100700）;

关键词：

肱骨干骨折骨折内固定髓内针钢板随机对照试验系统评价

DOI：

10.7507/1672-2531.20080149

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价钢板内固定与髓内针固定治疗成人肱骨干骨折的疗效。
方法　计算机检索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），手工检索《中华外科杂志》等6种中文主要外科杂志。收集钢板内固定与髓内针固定比较治疗成人肱骨干骨折的随机对照试验（RCT），评价纳入研究的方法学质量，并提取有效数据采用Stata 10.0软件进行Meta分析。
结果　共纳入6个RCT，共425例患者。文献异质性较小（P gt;0.1）。累积Meta分析结果表明，钢板内固定与髓内针固定比较，在再次手术发生率上，2000年以前（包括2000年）Meta分析结果为钢板内固定可显著降低再次手术发生率［OR=0.39，95%CI（0.17，0.90），P=0.03］，但2000年以后至今，两者再次手术发生率的差异无统计学差异［OR=0.54，95%CI（0.27，1.08），P=0.08］；在肩部撞击发生率上，钢板内固定显著低于髓内针固定［OR=0.13，95%CI（0.03，0.65），P=0.01］。在术后再次手术率、骨折不愈合率、医源性神经损伤、深部感染、内固定失败等方面，两者差异无统计学意义。对于术后骨折愈合时间、手术时间、出血（输血）量上，由于文献未提供详细数据，未能做Meta分析，只是进行描述性分析。
结论　与钢板内固定相比较，髓内针固定治疗成人肱骨干骨折容易导致肩部撞击的发生。在再次手术发生率、骨折不愈合率、医源性神经损伤、深部感染、内固定失败等方面，两者差异无统计学意义。因本次系统评价纳入病例数较少，尚需要更多设计严谨的大样本随机对照研究来增加证据的论证强度。

引用本文： 李连华,孙天胜,刘智,郭永智,李绍光,秦聪聪. 钢板内固定和髓内针固定比较治疗成人肱骨干骨折疗效的系统评价. 中国循证医学杂志, 2008, 08(8): 662-667. doi: 10.7507/1672-2531.20080149 复制

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, 吴泰相. 髓内针固定与钢板内固定比较治疗成人肱骨干骨折的系统评价. 中国循证医学杂志, 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, 吴泰相. 髓内针固定与钢板内固定比较治疗成人肱骨干骨折的系统评价. 中国循证医学杂志, 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.

《中国循证医学杂志》

钢板内固定和髓内针固定比较治疗成人肱骨干骨折疗效的系统评价

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《中国循证医学杂志》

钢板内固定和髓内针固定比较治疗成人肱骨干骨折疗效的系统评价

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