CAJ | 학술논문

背景：弹性髓内钉与外固定架修复儿童股骨干骨折是临床常用的两种固定形式，至于选择哪种固定方式更好目前仍存争议。目的：系统评价弹性髓内钉与外固定架修复儿童股骨干骨折的疗效。方法：计算机检索PubMed、Embase、Medline、Cochrane 图书馆数据库，检索时间从建刊至2014年11月25日，检索文献语种无限制。收集国内外公开发表的弹性髓内钉与外固定架修复儿童股骨干骨折的临床对照试验研究，患儿年龄3-15岁，应用改良Jadad方法学评分评价纳入文献的方法学质量，采用Stata 12.0软件进行Meta分析。结果与结论：纳入6篇研究文献，共237例患者。Meta分析显示,与外固定架相比，弹性髓内钉固定后总体并发症[RR=0.30，95%CI：0.19-0.46，P<0.001]与针道感染[RR=0.286，95%CI：0.13-0.61，P=0.001]的发生率较低，针尾激惹[RR=1.86，95%CI：1.35-2.56，P <0.001]的发生率较高，而两组其他指标相比差异无显著性意义。提示与外固定架相比，弹性髓内钉固定具有并发症少，骨折愈合快等优点，对于单纯性儿童股骨干骨折，推荐选择弹性髓内钉固定；而对于下肢高能量损伤、多发伤或伴有严重软组织损伤患者，外固定架是更好的选择。
배경：탄성수내정여외고정가수복인동고골간골절시림상상용적량충고정형식，지우선택나충고정방식경호목전잉존쟁의。목적：계통평개탄성수내정여외고정가수복인동고골간골절적료효。방법：계산궤검색PubMed、Embase、Medline、Cochrane 도서관수거고，검색시간종건간지2014년11월25일，검색문헌어충무한제。수집국내외공개발표적탄성수내정여외고정가수복인동고골간골절적림상대조시험연구，환인년령3-15세，응용개량Jadad방법학평분평개납입문헌적방법학질량，채용Stata 12.0연건진행Meta분석。결과여결론：납입6편연구문헌，공237례환자。Meta분석현시,여외고정가상비，탄성수내정고정후총체병발증[RR=0.30，95%CI：0.19-0.46，P<0.001]여침도감염[RR=0.286，95%CI：0.13-0.61，P=0.001]적발생솔교저，침미격야[RR=1.86，95%CI：1.35-2.56，P <0.001]적발생솔교고，이량조기타지표상비차이무현저성의의。제시여외고정가상비，탄성수내정고정구유병발증소，골절유합쾌등우점，대우단순성인동고골간골절，추천선택탄성수내정고정；이대우하지고능량손상、다발상혹반유엄중연조직손상환자，외고정가시경호적선택。
BACKGROUND:Flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures are two common methods in the clinic. It remains controversial which fixation methods are better. OBJECTIVE:To systematicaly evaluate the therapeutic effects of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures. METHODS: A computer-based search was performed on PubMed, Embase, Medline, and Cochrane library for literatures on clinical controled trials of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures published before November 25, 2014. Literature language was not limited. The age of subjects was from 3 to 15 years. Modified Jadad was utilized to assess methodological quality of the included studies. Meta-analysis was carried out using Stata 12.0 software. RESULTS AND CONCLUSION:Six papers involving 237 patients were included. Meta-analysis results showed that compared with external fixation, a low incidence of overal complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46;P < 0.001] and pin-hole infection (RR=0.286, 95%CI: 0.13-0.61;P= 0.001), but a high risk of needle tail irritation (RR=1.86, 95%CI: 1.35-2.56;P < 0.001) were found folowing flexible intramedulary nailing. No significant differences in other complications were found between the two groups. These results confirm that compared with external fixation, elastic intramedulary nail has fewer complications and faster fracture healing. Elastic intramedulary nail is recommended for single pediatric femoral shaft fractures. However, external fixation is a better option for high energy injury of lower limbs, multiple trauma or severely soft tissue injury.