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

目的 　系統(tǒng)評價髓內(nèi)釘固定與加壓鋼板內(nèi)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、CCT和中國生物醫(yī)學文獻數(shù)據(jù)庫（CBM）。手工檢索6種中文主要骨科雜志。收集髓內(nèi)釘固定與加壓鋼板內(nèi)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(zhì)量。統(tǒng)計軟件采用Cochrane協(xié)作網(wǎng)提供的RevMan 4.2.8。
結(jié)果 　共納入隨機對照試驗3篇，共215例患者，方法學質(zhì)量均為B級。Meta分析結(jié)果表明，髓內(nèi)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(jié)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(yī)源性橈神經(jīng)損傷率及感染率上，兩者差異無統(tǒng)計學意義。而骨折愈合時間因文獻未提供詳細數(shù)據(jù)未能做Meta分析。
結(jié)論 　與鋼板內(nèi)固定相比，髓內(nèi)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(jié)活動障礙更明顯。而在骨折不愈合率、醫(yī)源性橈神經(jīng)損傷率及感染率上，兩組差異無統(tǒng)計學意義。因本系統(tǒng)評價納入的病例數(shù)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(jù)的強度。

引用本文： 李 斌,白靖平,吳泰相. 髓內(nèi)釘固定與加壓鋼板內(nèi)固定比較治療成人肱骨干骨折的系統(tǒng)評價. 中國循證醫(yī)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(nèi)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. 1. 倪東亮,祝云利,林平.鋼板及交鎖髓內(nèi)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. 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. 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. 4. Christensen NO.Kuntscher intramedullary reaming and nail fixation for nonunion of the humerus. Clin Orthop Relat Res, 1976; (116): 222–225.
  5. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 15. Chacha PB. Compression plating without bone grafts for delayed and non-union of humeral shaft fractures. Injury, 1974; 5(4): 283–290.
  16. 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. 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.