■弹性稳定髓内钉(ESIN)和钢板是目前治疗小儿骨干股骨骨折(PDFF)的主要内固定,内固定的最佳选择是有争议的。这项荟萃分析的目的是比较两种固定方法的手术效果和并发症。
■MEDLINE,Embase,对Cochrane图书馆进行了系统的搜索,以查找截至3月发表的研究报告,2023年,比较了ESIN和钢板固定技术治疗PDFF。汇总分析确定了ESIN和钢板之间手术结局的差异,主要关于手术结果和术后并发症,比如手术时间,骨折愈合时间,失血和相关并发症。
■我们纳入了10项研究,纳入了775例PDFF患者。其中,428和347用ESIN和平板治疗,分别。在术后并发症方面,ESIN导致较短的手术时间[MD=-28.93,95%CI(-52.88至-4.98),P<0.05],失血较少[MD=-66.94,95%CI(-87.79至-46.10),P<0.001]和更多的骨折愈合时间[MD=2.65,95%CI(1.22-4.07),P<0.001]。在术后并发症方面,ESIN导致更少的感染(RR=0.77,95%CI0.37,1.60,P=0.48),成角畸形较少(RR=0.80,95%CI0.35,1.83,P=0.60),植入物较明显(RR=3.36,95%CI1.88,6.01,P<0.001),延迟愈合更多(RR=4.06,95%CI0.71,23.06,P=0.11)。
■ESIN和Plate具有相似的并发症发生率,而ESIN手术时间短,术中出血少。虽然这两种选择都是合适的,这项研究的结果支持在PDFF的并发症发生率方面使用ESIN而非平板治疗.在临床应用中,外科医生应根据实际情况选择合适的治疗方法。
UNASSIGNED: Elastic stable intramedullary nailing (ESIN) and plates are currently the main internal fixation for treating Pediatric Diaphyseal Femur Fractures (PDFF), and the optimal choice of internal fixation is controversial. The purpose of this meta-analysis is to compare the surgical outcomes and complications of the two fixation methods.
UNASSIGNED: MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to March, 2023, that compared ESIN and plate fixation techniques for treating PDFF. Pooled analysis identified differences in surgical outcomes between ESIN and plate, mainly regarding surgical outcomes and postoperative complications, such as time at surgery, fracture healing time, blood loss and related complications.
UNASSIGNED: We included 10 studies with 775 patients with PDFF in our review. Of these, 428 and 347 were treated with ESIN and Plate, respectively. In terms of postoperative complications, ESIN led to a shorter surgery time [MD = - 28.93, 95% CI (- 52.88 to - 4.98), P < 0.05], less blood loss [MD = - 66.94, 95% CI (- 87.79 to - 46.10), P < 0.001] and more fracture healing time [MD = 2.65, 95% CI (1.22-4.07), P < 0.001]. In terms of postoperative complications, ESIN led to fewer fections (RR = 0.77, 95% CI 0.37, 1.60, P = 0.48), fewer angulation deformities (RR = 0.80, 95% CI 0.35, 1.83, P = 0.60) and more prominent implants (RR = 3.36, 95% CI 1.88, 6.01, P < 0.001), more delayed unions (RR = 4.06, 95% CI 0.71, 23.06, P = 0.11).
UNASSIGNED: ESIN and Plate have similar rates of complications besides a prominent implant rate, while ESIN has a shorter period of operation and less intraoperative bleeding. Although both options are suitable, the results of this study support the use of ESIN rather than plates in the treatment of PDFF in terms of complication rates. In clinical applications, surgeons should choose the appropriate treatment method according to the actual situation.