CAJ | 학술논문

目的：随着股骨远端骨折内固定材料的种类逐渐增多，对术者手术方式的选择提出了更高的要求。文中通过对带锁髓内钉与钢板治疗成人股骨远端骨折的Meta分析，为确定成人股骨远端骨折的手术方案提供理论依据。方法计算机检索Cochrane图书馆、HighWire、CNKI、PubMed、超星MedaLink、万方医学数据库，并手工检索相关杂志，检索日期从2003年6月至2013年6月。对符合纳入标准的研究进行资料提取、质量评价后采用RevMan5．1软件进行Meta分析。结果纳入10项研究，共计1200例患者，其中髓内钉组545例，钢板组655例。 Meta分析结果显示：髓内钉治疗成人股骨远端骨折较钢板组术后总体并发症的发生率明显降低[RR＝0．48，95％CI（0．35，0．67），P＜0．01]，住院时间缩短[WMD＝-3．55，95％CI （-4．89，-2．24），P＜0．01]，负重时间缩短[WMD＝-0．80，95％CI（-1．49，-0．10），P＝0．02]，愈合时间缩短[WMD＝-3．32，95％CI（-3．72，-2．92），P＜0．01]。且髓内钉组手术时间短于钢板组[WMD＝-6．49，95％CI（-8．94，-4．05），P＜0．001]，出血量亦小于钢板组[WMD＝-71．37，95％CI（-76．28，-66．46），P＜0．001]。结论髓内钉治疗成人股骨远端骨折可减少术后并发症的发生，并且在手术时间、住院时间、愈合时间、负重时间及出血量等方面优于钢板组。受纳入文献质量的影响，以上结论需要高质量的随机对照试验进一步证实。
목적：수착고골원단골절내고정재료적충류축점증다，대술자수술방식적선택제출료경고적요구。문중통과대대쇄수내정여강판치료성인고골원단골절적Meta분석，위학정성인고골원단골절적수술방안제공이론의거。방법계산궤검색Cochrane도서관、HighWire、CNKI、PubMed、초성MedaLink、만방의학수거고，병수공검색상관잡지，검색일기종2003년6월지2013년6월。대부합납입표준적연구진행자료제취、질량평개후채용RevMan5．1연건진행Meta분석。결과납입10항연구，공계1200례환자，기중수내정조545례，강판조655례。 Meta분석결과현시：수내정치료성인고골원단골절교강판조술후총체병발증적발생솔명현강저[RR＝0．48，95％CI（0．35，0．67），P＜0．01]，주원시간축단[WMD＝-3．55，95％CI （-4．89，-2．24），P＜0．01]，부중시간축단[WMD＝-0．80，95％CI（-1．49，-0．10），P＝0．02]，유합시간축단[WMD＝-3．32，95％CI（-3．72，-2．92），P＜0．01]。차수내정조수술시간단우강판조[WMD＝-6．49，95％CI（-8．94，-4．05），P＜0．001]，출혈량역소우강판조[WMD＝-71．37，95％CI（-76．28，-66．46），P＜0．001]。결론수내정치료성인고골원단골절가감소술후병발증적발생，병차재수술시간、주원시간、유합시간、부중시간급출혈량등방면우우강판조。수납입문헌질량적영향，이상결론수요고질량적수궤대조시험진일보증실。
Objective Along with the development of science and technology , increase in the number of species gradually distal femoral fractures internal fixation materials , the choice of performer operation method is put forward to the test .To provide theo-retical basis for surgery of adult distal femoral fractures by systematically compare the distal femoral fractures in adults treated by intr -amedullary nail and plate . Methods We searched for articles comparing intramedullary nail and plate for distal femoral fractures in adults in Cochrane library, HighWire, CNKI, PubMed, super star MedaLink, Wanfang database.Manual retrieval related magazines, the retrieve date from June 2003 to June 2013.The RevMan5.1 provided for the extraction of available data after evaluate the quality of eligible literature . Results A total of 1200 patients were included ( 545 in the intramedullary nailing group and 655 in the plate group).Compared with the plate, intramedullary nail significantly reduced the risk of total complications (RR=0.48,95%CI[0.35, 0.67],P<0.01).Shorten the hospital stay (WMD =-3.55,95%CI[ -4.89, -2.24], P <0.01),full weight-bearing time (WMD=-0.80,95%CI[-1.49,-0.10],P=0.02), healing time(WMD=-3.32,95%CI[ -3.72,-2.92],P<0.01), all the above differences are statistically significant .In addition, this study found that intramedullary nail group is better in operation time and blood loss than steel group , but the conclusion by contrast in some literature . Conclusion Intramedullary nailing treatment of distal femoral fractures in adults can decrease the occurrence of postoperative complications .And in the operation time , hospitalization time, healing time, load time and blood loss, etc is superior to the steel group .Influenced by quality into literature , the above conclu-sion needs high quality case-control study further confirmed .