• 1. 新疆醫(yī)科大學2003級研究生班,烏魯木齊,8300542. 新疆醫(yī)科大學第一附屬醫(yī)院骨科,烏魯木齊,8300543. 四川大學華西醫(yī)院中國循證醫(yī)學中心/臨床流行病學資源與培訓中心,成都,成都,610041　;

目的 　對非擴髓與擴髓髓內(nèi)釘固定治療成人脛骨干骨折的療效進行評價.
方法 　計算機檢索MEDLINE(1966～2005.7)、EMBASE(1974～2005.7)、Cochrane圖書館(2005年第2期)及中國生物醫(yī)學文獻數(shù)據(jù)庫(1979～2005.7),手工檢索相關的中英文骨科雜志.收集非擴髓與擴髓髓內(nèi)釘固定術相比較治療成人脛骨干骨折療效的臨床隨機對照和半隨機對照試驗,并評價納入研究的方法學質(zhì)量.統(tǒng)計軟件用Cochrane協(xié)作網(wǎng)提供的RevMan 4.2.7.
結果 　共納入非擴髓與擴髓髓內(nèi)釘固定術相比較治療成人脛骨干骨折療效的臨床隨機對照試驗4個及半隨機對照試驗1個.Meta分析表明,非擴髓與擴髓髓內(nèi)釘固定治療成人脛骨干骨折相比較,其骨折不愈合率升高 [RR=1.87, 95%CI (1.20,2.91), P=0.006],內(nèi)置物失效率顯著升高 [RR=2.23, 95%CI (1.49,3.34), P﹤0.000 1];骨折愈合時間延長 [WMD=9.00, 95%CI (3.19,14.81), P=0.002].　
結論 　與擴髓髓內(nèi)釘固定相比較,非擴髓髓內(nèi)釘固定治療成人脛骨干骨折時骨折不愈合率升高及內(nèi)置物失效更常見.擴髓與否在術后感染率、骨折畸形愈合率、骨筋膜室綜合征發(fā)生率的差異上無統(tǒng)計學意義.但在嚴重開放性骨折(Gustilo Grade ⅢC)合并多發(fā)損傷時,擴髓與非擴髓對上述指標的影響尚有待于進一步研究.

引用本文： 彭 斌,田 禾,吳泰相. 非擴髓與擴髓髓內(nèi)釘固定治療成人脛骨干骨折的系統(tǒng)評價. 中國循證醫(yī)學雜志, 2005, 05(10): 778-785. doi: 復制

1. Court-Brown CM,Christie J,McQueen MM.Closed intramedullary tibial nailing.Its use in closed and type I open fractures[J].J Bone Joint Surg Br,1990;72(4):605-611.
2. Ekeland A,Thoresen BO,Alho A,Stromsoe K,Folleras G,Haukebo A.Interlocking intramedullary nailing in the treatment of tibial fractures:a report of 45 cases[J].Clin Orthop,1988;(231):205-215.
3. Bone LB,Johnson KD.Treatment of tibial fractures by reaming and intramedullary nailing[J].J Bone Joint Surg,1986;68(6):877-887.
4. Reichert IL,McCarthy ID,Hughes SP.The acute vascular response to intramedullary reaming:microsphere estimation of blood flow in the intact ovine tibia[J].J Bone Joint Surg Br,1995;77(3):490-493.
5. Klein MP,Rahn BA,Frigg R,Kessler S,Perren SM.Reaming versus non-reaming in medullarynailing:interference with cortical circulation of the canine tibia[J].Arch Orthop Trauma Surg,1990;109(6):314-316.
6. Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM.Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia[J].J Orthop Res,1995;13(3):382-389.
7. Melcher GA,Hauke C,Metzdorf A,Perren SM,Printzen G,Schlegel U,Ziegler WJ.Infection after intramedullarynailing:an experimental investigation on rabbits[J].Injury,1996;27(suppl3):23-26.
8. Kessler SB,Hallfeldt KK,Perren SM,Schweiberer L.The effects of reaming and intramedullary nailing on fracture healing[J].Clin Orthop,1986;(212):18-25.
9. Gregory P,Sanders R.The treatment of closed,unstable tibial fractures with undreamed interlocking nails[J].Clin Orthop,1995;(315):48-55.
10. Rhinelander FW.Tibial blood supply in relation to fracture healing[J].Clin Orthop,1974;105(0):34-81.
11. Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM,Senft D.Effects of reamed versus unreamed locked nailing on callus blood flow and early strength of union in a fractured sheep tibia model[J].Orthop Trans,1994;18(2):145.
12. Sitter T,Wilson J,Browner B.The effect of reamed vs unreamed nailing on intramedullary blood supply on cortical viability[abstract][J].J Orthop Trauma,1990;4(3):232.
13. Anglen JO,Blue JM.A comparison of reamed and unreamed nailing of the tibia[J].J Trauma,1995;39(2):351-355.
14. Blachut PA,O’Brien PJ,Meek RN,Broekhuyse HM.Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(5):640-646.
15. Court-Brown CM,Will E,Christie J,McQueen MM.Reamed or unreamed nailing for closed tibial fractures:a prospective study in Tscherne C1 fractures[J].J Bone Joint Surg,1996;78(4):580-583.
16. Finkemeier CG,Schmidt AH,Kyle RF,Templeman DC,Varecka TF.A prospective randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft[J].J Orthop Trauma,2000;14(3):187-193.
17. Keating JF,O’Brien PJ,Blachut PA,Meek RN,Broekhuyse HM.Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(3):334-341.
18. Mayr E,Barnikel C,Braun W,Ruter A.Closed tibial fractures reamed or unreamed intramedullary nailing:A clinical study[J].Zentralbl Chir,1995;120(1):24-30.
19. Ruchholtz S,Nast-Kolb D,Betz A,Schweiberer L.Fracture healing after intramedullary nailing of simple tibial shaft fractures.A clinical comparison of reamed and unreamed procedures[J].Unfallchirurg,1995;98(7):369-375.
20. Leif B(o\/)rge Larsen,Madsen JE.Hoiness PR.Ovre S.Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective,randomized study with 3.8 years follow-up[J].J Orthop Trauma,2004;18(3):144-149.
21. Beadel G,McKee J.Reamed versus unreamed tibial nails.A prospective randomised trial[J].J Bone Joint Surg Br,2002;84B (Suppl Ⅱ):132.
22. Alderson P,Green S,Higgins JPT,editors.Cochrane Reviewers Handbook 4.2.1[updated December 2003].Section 6.In:The Cochrane Library.The Cochrane Collaboration.Oxford:2004,Issue 1.
23. Moher D,Cook DJ,Eastwood S,Olkin I,Rennie D,Stroup DF.For the QUOROM group:Improving the quality of reports of Mata-analyses of randomized controlled trials:the QUOROM statement[J].Lancet,1999;354(9193):1896-1900.
24. 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.
25. Fotster MC,Bruce AS,Aster AS.Should the tibia be reamed when nailing[J].Injury,2005;36(3):439-444.
26. Pape HC,Dwenger A,Regel G,Schweitzer G,Jonas M,Remmers D,Krumm K,Neumann C,Sturm JA,Tscherne H.Pulmonary damage after intramedullary femoral in traumatized sheep:Is there an effect from different nailing methods[J].J Trauma,1992;33(4):574-581.
27. Manning JB,Bach AW,Herman CM,Carrico CJ.Fat release after femur nailing in the dog[J].J Trauma,1983;23(4):322-326.
28. Wolinsky PR,Banit D,Parker RE,Shyr Y,Snapper JR,Rutherford EJ,Johnson KD.Reamed intramedullary femoral nailing after induction of an "ARDS-like" state in sheep:effect on clinically applicable markers of pulmonary function[J].J Orthop Trauma,1998;12(3):169-176.
29. Nassif JM,Gorczyca JT,Cole JK,Pugh KJ,Pienkowski D.Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures:a randomized prospective study[J].J Orthop Trauma,2000;14(8):554-558.
  1. 1. Court-Brown CM,Christie J,McQueen MM.Closed intramedullary tibial nailing.Its use in closed and type I open fractures[J].J Bone Joint Surg Br,1990;72(4):605-611.
  2. 2. Ekeland A,Thoresen BO,Alho A,Stromsoe K,Folleras G,Haukebo A.Interlocking intramedullary nailing in the treatment of tibial fractures:a report of 45 cases[J].Clin Orthop,1988;(231):205-215.
  3. 3. Bone LB,Johnson KD.Treatment of tibial fractures by reaming and intramedullary nailing[J].J Bone Joint Surg,1986;68(6):877-887.
  4. 4. Reichert IL,McCarthy ID,Hughes SP.The acute vascular response to intramedullary reaming:microsphere estimation of blood flow in the intact ovine tibia[J].J Bone Joint Surg Br,1995;77(3):490-493.
  5. 5. Klein MP,Rahn BA,Frigg R,Kessler S,Perren SM.Reaming versus non-reaming in medullarynailing:interference with cortical circulation of the canine tibia[J].Arch Orthop Trauma Surg,1990;109(6):314-316.
  6. 6. Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM.Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia[J].J Orthop Res,1995;13(3):382-389.
  7. 7. Melcher GA,Hauke C,Metzdorf A,Perren SM,Printzen G,Schlegel U,Ziegler WJ.Infection after intramedullarynailing:an experimental investigation on rabbits[J].Injury,1996;27(suppl3):23-26.
  8. 8. Kessler SB,Hallfeldt KK,Perren SM,Schweiberer L.The effects of reaming and intramedullary nailing on fracture healing[J].Clin Orthop,1986;(212):18-25.
  9. 9. Gregory P,Sanders R.The treatment of closed,unstable tibial fractures with undreamed interlocking nails[J].Clin Orthop,1995;(315):48-55.
  10. 10. Rhinelander FW.Tibial blood supply in relation to fracture healing[J].Clin Orthop,1974;105(0):34-81.
  11. 11. Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM,Senft D.Effects of reamed versus unreamed locked nailing on callus blood flow and early strength of union in a fractured sheep tibia model[J].Orthop Trans,1994;18(2):145.
  12. 12. Sitter T,Wilson J,Browner B.The effect of reamed vs unreamed nailing on intramedullary blood supply on cortical viability[abstract][J].J Orthop Trauma,1990;4(3):232.
  13. 13. Anglen JO,Blue JM.A comparison of reamed and unreamed nailing of the tibia[J].J Trauma,1995;39(2):351-355.
  14. 14. Blachut PA,O’Brien PJ,Meek RN,Broekhuyse HM.Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(5):640-646.
  15. 15. Court-Brown CM,Will E,Christie J,McQueen MM.Reamed or unreamed nailing for closed tibial fractures:a prospective study in Tscherne C1 fractures[J].J Bone Joint Surg,1996;78(4):580-583.
  16. 16. Finkemeier CG,Schmidt AH,Kyle RF,Templeman DC,Varecka TF.A prospective randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft[J].J Orthop Trauma,2000;14(3):187-193.
  17. 17. Keating JF,O’Brien PJ,Blachut PA,Meek RN,Broekhuyse HM.Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(3):334-341.
  18. 18. Mayr E,Barnikel C,Braun W,Ruter A.Closed tibial fractures reamed or unreamed intramedullary nailing:A clinical study[J].Zentralbl Chir,1995;120(1):24-30.
  19. 19. Ruchholtz S,Nast-Kolb D,Betz A,Schweiberer L.Fracture healing after intramedullary nailing of simple tibial shaft fractures.A clinical comparison of reamed and unreamed procedures[J].Unfallchirurg,1995;98(7):369-375.
  20. 20. Leif B(o\/)rge Larsen,Madsen JE.Hoiness PR.Ovre S.Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective,randomized study with 3.8 years follow-up[J].J Orthop Trauma,2004;18(3):144-149.
  21. 21. Beadel G,McKee J.Reamed versus unreamed tibial nails.A prospective randomised trial[J].J Bone Joint Surg Br,2002;84B (Suppl Ⅱ):132.
  22. 22. Alderson P,Green S,Higgins JPT,editors.Cochrane Reviewers Handbook 4.2.1[updated December 2003].Section 6.In:The Cochrane Library.The Cochrane Collaboration.Oxford:2004,Issue 1.
  23. 23. Moher D,Cook DJ,Eastwood S,Olkin I,Rennie D,Stroup DF.For the QUOROM group:Improving the quality of reports of Mata-analyses of randomized controlled trials:the QUOROM statement[J].Lancet,1999;354(9193):1896-1900.
  24. 24. 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.
  25. 25. Fotster MC,Bruce AS,Aster AS.Should the tibia be reamed when nailing[J].Injury,2005;36(3):439-444.
  26. 26. Pape HC,Dwenger A,Regel G,Schweitzer G,Jonas M,Remmers D,Krumm K,Neumann C,Sturm JA,Tscherne H.Pulmonary damage after intramedullary femoral in traumatized sheep:Is there an effect from different nailing methods[J].J Trauma,1992;33(4):574-581.
  27. 27. Manning JB,Bach AW,Herman CM,Carrico CJ.Fat release after femur nailing in the dog[J].J Trauma,1983;23(4):322-326.
  28. 28. Wolinsky PR,Banit D,Parker RE,Shyr Y,Snapper JR,Rutherford EJ,Johnson KD.Reamed intramedullary femoral nailing after induction of an "ARDS-like" state in sheep:effect on clinically applicable markers of pulmonary function[J].J Orthop Trauma,1998;12(3):169-176.
  29. 29. Nassif JM,Gorczyca JT,Cole JK,Pugh KJ,Pienkowski D.Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures:a randomized prospective study[J].J Orthop Trauma,2000;14(8):554-558.