Comparative Efficacy and Safety of Intramedullary Lengthening Nails vs. Alternative Techniques for Femoral Limb Lengthening: A Systematic Review and Meta-Analysis.

IF 1.7 Q2 SURGERY

JBJS Reviews Pub Date : 2024-10-22 eCollection Date: 2024-10-01 DOI:10.2106/JBJS.RVW.24.00113

Amirali Azimi, John E Herzenberg, Shayan Roshdi Dizaji, Philip K McClure, Fatemeh-Sadat Tabatabaei, Amir Farbod Azimi

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引用次数: 0

Abstract

Background: Limb lengthening procedures are performed for various indications, including limb length discrepancies (LLDs) and short stature. This systematic review and meta-analysis compares the efficacy and safety of the newer motorized intramedullary lengthening nails (MILNs) with the traditional alternative techniques (ATs) for femoral limb lengthening.

Methods: We conducted a comprehensive literature search in the Medline, Embase, Cochrane, Web of Science, and Scopus databases, inclusive of all dates through July 1, 2023, and without language restrictions. Factors mediating outcomes included problems, obstacles, complications, total adverse events, healing/consolidation index, time to full weight-bearing, lengthening accuracy, percentage of lengthening goal achieved, and duration of hospital stay. Effect sizes were quantified using STATA 17.0. Statistical algorithms employed were random effects model standardized mean differences (SMDs) for continuous outcomes and log risk ratios (RRs) for dichotomous outcomes, both with 95% confidence intervals (CIs).

Results: Our meta-analysis included 10 studies comparing MILN with AT: 180 femurs in the MILN group and 160 femurs in the AT group. This was exclusively comprised of retrospective cohort studies. When compared with AT, limb lengthening procedures utilizing MILNs had significantly lower problems (log RR, -1.35; 95% CI, -1.93 to -0.77; p < 0.001), complications (log RR, -0.56; 95% CI, -0.90 to -0.22; p = 0.001), and total adverse events (log RR, -0.69; 95% CI, -1.17 to -0.21; p = 0.005), as well as a superior bone healing index (SMD, -0.80; 95% CI, -1.32 to -0.28; p = 0.003). However, no significant differences were found in obstacles, percentage of lengthening goal achieved, lengthening accuracy, time to full weight-bearing, and duration of hospital stay.

Conclusion: Limb lengthening with MILNs vs. AT may offer more favorable patient outcomes, lowering risk for problems, complications, and total adverse events, while optimizing the bone healing/consolidation index. However, the limitation of nonrandomized retrospective studies and high heterogeneity should be acknowledged.

Level of evidence: Level II (meta-analysis of cohort studies). See Instructions for Authors for a complete description of levels of evidence.

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髓内加长钉与其他股骨肢体加长技术的疗效和安全性比较：系统回顾与元分析》。

背景：肢体延长手术有多种适应症，包括肢体长度差异（LLD）和身材矮小。本系统综述和荟萃分析比较了新型电动髓内加长钉（MILN）与传统替代技术（AT）在股骨肢体延长方面的有效性和安全性：我们在 Medline、Embase、Cochrane、Web of Science 和 Scopus 数据库中进行了全面的文献检索，检索日期均截止到 2023 年 7 月 1 日，且无语言限制。影响结果的因素包括问题、障碍、并发症、不良事件总数、愈合/巩固指数、完全负重时间、延长准确性、达到延长目标的百分比以及住院时间。效果大小使用 STATA 17.0 进行量化。连续性结果采用随机效应模型标准化均值差异（SMDs），二分法结果采用对数风险比（RRs），两者均有 95% 的置信区间（CIs）：我们的荟萃分析包括 10 项比较 MILN 与 AT 的研究：MILN 组 180 例股骨，AT 组 160 例股骨。这些研究均为回顾性队列研究。与AT相比，使用MILN进行肢体延长手术的问题（log RR, -1.35; 95% CI, -1.93 to -0.77; p < 0.001）、并发症（log RR, -0.56; 95% CI, -0.90至-0.22；p = 0.001）、总不良事件（对数RR，-0.69；95% CI，-1.17至-0.21；p = 0.005）以及骨愈合指数（SMD，-0.80；95% CI，-1.32至-0.28；p = 0.003）均优于对照组。然而，在障碍、达到延长目标的百分比、延长准确性、完全负重时间和住院时间方面没有发现明显差异：结论：使用MILNs与AT进行肢体延长可能会为患者带来更有利的结果，降低问题、并发症和不良事件的风险，同时优化骨愈合/巩固指数。然而，应承认非随机回顾性研究的局限性和高度异质性：证据等级：二级（队列研究荟萃分析）。有关证据等级的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.