【作者】 彭斌；

【导师】 田禾；

【作者基本信息】 新疆医科大学 ， 骨科， 2006， 硕士

【摘要】 目的：对非扩髓与扩髓髓内钉固定治疗成人胫骨干骨折的疗效进行评价。方法：计算机检索MEDLINE(1966～2005．7)、EMBASE(1966～2005．7)、Cochrane图书馆(2005年第2期)及中国生物医学数据库(1979～2005．7)，手工检索相关的中英文骨科杂志。收集所有非扩髓与扩髓髓内钉固定术相比较治疗成人胫骨干骨折疗效的临床随机对照和半随机对照试验，并评价纳入研究的方法学质量。统计软件用Cochrane协作网提供的RevMan4．2．7。结果：共纳入非扩髓与扩髓髓内钉固定术相比较治疗成人胫骨干骨折疗效的临床随机对照试验4个及半随机对照试验1个。Meta分析表明，非扩髓与扩髓髓内钉固定治疗成人胫骨干骨折相比较骨折不愈合率升高[RR=1.87，95％CI(1.20，2.91)，P=0.006]；内置物失效率显著升高[RR=2.23，95％CI(1.49，3.34)，P＜0.0001]；骨折愈合时间延长[WMD=9.00，95％CI(3.19，14.81)，P=0.002]。结论：与扩髓髓内钉固定相比，非扩髓髓内钉固定治疗成人胫骨干骨折时骨折不愈合率升高及内置物失效更常见。扩髓与否在术后感染率、骨折畸形愈合率、骨筋膜室综合征发生率上两组差异无统计学意义。在严重开放性骨折(Gustilo Grade ⅢC)，合并多发损伤时，扩髓与否对上述指标的影响有待于进一步研究。更多还原

【Abstract】 Objective: To determine the effect of non-reamed versus reamed intramedullary nailing for tibial fractures in adult on the rates of nonunion, the rates of implant failure, the rates of infection, the incidence of compartment syndrome, the rates of malunion and the time of union. Methods:We searched MEDLINE (1966-July, 2005), EMBASE (1966-July, 2005), The Cochrane Library (Issue 2, 2005), CBMdisc (1979-July, 2005); and handsearched the relevant Chinese and English orthopedic journals. RCTs and CCTs of non-reamed versus reamed intramedullary nailing for tibial fractures in adult were included, The quality of trials was critically assessed. RevMan 4.2.7 software was used for data analysis. Results: Four RCTs and one CCTs of non-reamed versus reamed intramedullary nailing for tibial fractures in adult were included, The results of meta-analysis showed that non-reamed intramedullary nailing for tibial fractures in adult increase the rates of nonunion (RR 1.87, 95%CI 1.20 to 2.91, P=0.006), implant failure (RR 2.23, 95%CI 1.49 to 3.34, P<0.0001) and the time to union (WMD 9.00, 95%CI 3.19 to 14.81, P=0.002). Conclusion: Compared with reamed intramedullary nailing for tibial fractures in adults, non-reamed intramedullary nailing increase the rates of nonunion and implant failure was common, There were no statistical difference in the rates of infection and the rates of infection and the incidence of compartment syndrome in both group. However, the effect of reamed or not to these outcomes need更多还原