CAJ | 학술논문

背景：随着微创技术的发展，越来越多的前臂骨折尤其儿童前臂骨折采用弹性髓内钉技术内固定，近几年也有应用于大龄儿童，甚至成年人的文献报道，特别是对于开放性骨折和不稳定性骨折，应用该技术已取得良好的疗效。目的：采用循证医学方法评价弹性髓内钉及钢板内固定修复前臂骨折的临床疗效和安全性。方法：计算机检索PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库、万方数据库，并辅以其他检索。按照 Cochrane 系统评价方法评价纳入研究的质量，采用RevMan 5.2软件进行统计分析。结果与结论：共纳入7个随机对照试验，共468例患者。Meta分析结果显示，弹性髓内钉治疗前臂骨折与钢板内固定相比可提高总有效率(P <0.0001)，缩短骨折X射线愈合时间(P <0.00001)，缩短住院时间(P <0.00001)。在不良反应方面，弹性髓内钉组再骨折(P=0.03)、内固定物断裂(P=0.03)发生率明显减少。提示与钢板内固定相比，应用弹性髓内钉内固定修复前臂骨折能够提高总有效率，缩短骨折X射线愈合时间及住院时间，同时能够减少再骨折及内固定物断裂等并发症的发生。
배경：수착미창기술적발전，월래월다적전비골절우기인동전비골절채용탄성수내정기술내고정，근궤년야유응용우대령인동，심지성년인적문헌보도，특별시대우개방성골절화불은정성골절，응용해기술이취득량호적료효。목적：채용순증의학방법평개탄성수내정급강판내고정수복전비골절적림상료효화안전성。방법：계산궤검색PubMed、EMBASE、Cochrane Library화중국생물의학문헌수거고、중문과기기간전문수거고、중국기간전문수거고、만방수거고，병보이기타검색。안조 Cochrane 계통평개방법평개납입연구적질량，채용RevMan 5.2연건진행통계분석。결과여결론：공납입7개수궤대조시험，공468례환자。Meta분석결과현시，탄성수내정치료전비골절여강판내고정상비가제고총유효솔(P <0.0001)，축단골절X사선유합시간(P <0.00001)，축단주원시간(P <0.00001)。재불량반응방면，탄성수내정조재골절(P=0.03)、내고정물단렬(P=0.03)발생솔명현감소。제시여강판내고정상비，응용탄성수내정내고정수복전비골절능구제고총유효솔，축단골절X사선유합시간급주원시간，동시능구감소재골절급내고정물단렬등병발증적발생。
BACKGROUND:With the development of minimal y invasive technique, more and more forearm fracture, especial y in children, was treated by elastic stable intramedul ary nailing. Recently, elastic stable intramedul ary nailing was also used in elder children, even adults. In particular, this technique has obtained good curative effects for open fracture and unstable fracture. OBJECTIVE:To evaluate the clinical effectiveness and safety of elastic intramedul ary nail and plate fixation for double fracture of forearm using evidence-based medicine. METHODS:We retrieved PubMed, Embase, Cochrane Library, China Biology Medicine, VIP, China National Knowledge Infrastructure, WanFang, and other electronic databases. The quality of the included studies was assessed using Cochrane Systematic Review. The analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION:A total of 7 randomized control ed trials involving 468 cases were included. The results of meta-analyses showed that compared with plate fixation group, effective rate was higher in the titanium elastic nail group (P<0.000 1), the time of fracture healing was shorter (P<0.000 01), and the hospitalization time was shorter (P<0.000 01). In the aspect of adverse reactions, incidence of refracture (P=0.03) and breakage of internal fixation (P=0.03) was significantly lower. These indicated that compared with plate fixation, titanium elastic nail can improve the total effective rate, shorten the time of fracture healing on X-ray and the hospitalization time, at the same time, can effectively reduce the complications of refracture and breakage of internal fixation.