【摘要】 [目的]应用系统评价的方法比较开放性胫腓骨骨折治疗中应用交锁髓内钉与外固定的疗效,为临床实践与研究提供参考。[方法]计算机检索中国期刊全文数据库、中文科技期刊全文数据库、万方数据库、Pubmed、Web of Science关于交锁髓内钉和外固定治疗开放性胫腓骨骨折疗效比较的研究,末次检索时间为2015年7月,选择适合本研究特点的质量评价标准对纳入文献进行质量评价,使用Stata 13.0软件进行Meta分析。[结果]通过检索得到相关文献163篇,根据纳入、排除标准最后筛选得到14篇文献,包括开放性胫腓骨骨折患者1 101例。其中,交锁髓内钉治疗组517例,外固定治疗组584例。对比交锁髓内钉和外固定治疗开放性胫腓骨骨折的愈合优良率(Johner-Wruh标准评定疗效)(OR=2.21,95%CI=1.48-3.31,P=0.0001)差异有统计学意义,而术后感染的发生率(OR=1.52,95%CI=0.91-2.55,P=0.291)、骨折愈合时间(SMD=-0.38,95%CI=-1.08-0.33,P=0.296)、术后延迟愈合或不愈合的发生率(OR=1.38 95%CI=0.79-2.44,P=0.266),术后骨不连的发生率(OR=1.22,95%CI=0.46-3.26,P=0.693),差异没有统计学意义。[结论]交锁髓内钉治疗开放性胫腓骨骨折优于外固定组。更多还原

【Abstract】 [Objective] To systematically evaluate the efficacy of interlocking intramedullary nails versus external fixation in the treatment of open fractures of the tibia and fibula, and to provide a reference for clinical practice and research.[Methods] A literature search was performed in CNKI, VIP database, Wan Fang Data, Pub Med, and Web of Science to collect the clinical studies which compared the efficacy of interlocking intramedullary nail versus external fixation in the treatment of open fractures of the tibia and fibula published up to July 2015. A meta-analysis was performed using Stata 13.0 after quality assessment. [Results] A total of 163 studies were collected, and only 14 of them were included in the meta-analysis involving 1101 patients with open fractures of the tibia and fibula. The patients were divided into interlocking intramedullary nail group(n = 517) and external fixation group(n = 584). There was a significant difference in the excellent and good results rate(Johner-Wruh criteria) between the two groups(OR = 2.21, 95% CI =1.48-3.31,P = 0.0001). There were no significant differences in postoperative infection rate(OR = 1.52,95% CI = 0.91-2.55,P = 0.291),fracture healing time(SMD =-0.38,95% CI =-1.08-0.33,P = 0.296),the rate of nonunion and delayed union(OR = 1.38, 95% CI =0.79-2.44, P = 0.266), and the rate of malunion(OR=1.22,95% CI=0.46-3.26,P=0.693) between the two groups.[Conclusions] Compared with external fixation,interlocking intramedullary nails has better clinical efficacy in the treatment of open fractures of the tibia and fibula.更多还原