Efficacy and complications of blocking screws fixation in the treatment of lower limb long bone fracture: a meta-analysis.

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2025-03-21 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1560150

Zhaoguo Jin, Ding Wang

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引用次数: 0

Abstract

Background: Long bone fractures, especially in the lower limbs, are highly prevalent in orthopedic practice. These fractures can significantly impair patients' mobility and quality of life. Intramedullary nails are a mainstay treatment, offering reliable fracture fixation. However, the addition of blocking screws has introduced an element of uncertainty regarding surgical outcomes. This meta-analysis evaluated the efficacy and complications of blocking screw fixation for lower limb long bone fractures (LLLBF).

Methods: A comprehensive and systematic search was conducted across eight databases, namely the Cochrane Library, PubMed, EMbase, Web of Science, CNKI, China Biomedical Literature Database (CBM), VIP, and WanFang, to identify relevant controlled trials. Before data analysis, the quality of each study was rigorously assessed. Subsequently, the data were analyzed using the Review Manager 5.3 (RevMan 5.3) software to ensure a reliable and accurate synthesis of the evidence.

Results: A total of 15 studies were incorporated into the analysis. Compared with the control group, the experimental group demonstrated a significantly shorter fracture healing time (standardized mean difference, SMD = -2.18; 95% confidence interval, CI: -3.17 to -1.20; P < 0.001), suggesting a substantial effect in favor of the intervention. Additionally, the experimental group had a longer operation time (SMD = 15.81, 95% CI: 4.28, 27.34, P = 0.007), less intraoperative bleeding (SMD = -75.60, 95% CI: -127.93, -23.27, P = 0.005), and fewer complications (odds ratio, OR = 0.51, 95% CI: 0.31, 0.84, P = 0.008). However, no significant difference was observed in the fracture healing rates between the two groups (OR = 1.09, 95% CI: 0.98, 1.20, P = 0.098).

Conclusion: The findings of this study suggest that the use of intramedullary nails in conjunction with blocking screws could potentially be an effective treatment option for patients with lower limb long bone fractures. However, to confirm this efficacy, additional high - quality research, preferably well-designed randomized controlled trials with large sample sizes and long-term follow - up, is warranted.

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阻断螺钉固定治疗下肢长骨骨折的疗效及并发症：荟萃分析。

背景：长骨骨折，尤其是下肢骨折，在骨科实践中非常普遍。这些骨折会严重影响患者的活动能力和生活质量。髓内钉是主要的治疗方法，提供可靠的骨折固定。然而，闭塞螺钉的加入给手术结果带来了不确定因素。本荟萃分析评估了阻断螺钉固定治疗下肢长骨骨折（LLLBF）的疗效和并发症。方法：通过Cochrane Library、PubMed、EMbase、Web of Science、中国知网（CNKI）、中国生物医学文献数据库（CBM）、VIP、万方等8个数据库进行全面系统检索，筛选相关对照试验。在数据分析之前，每个研究的质量都经过严格的评估。随后，使用Review Manager 5.3 （RevMan 5.3）软件对数据进行分析，以确保可靠和准确地合成证据。结果：共纳入15项研究。与对照组相比，实验组骨折愈合时间明显缩短(标准化平均差，SMD = -2.18；95%置信区间，CI: -3.17 ~ -1.20；P = 0.007)，术中出血较少（SMD = -75.60, 95% CI: -127.93, -23.27, P = 0.005），并发症较少（优势比OR = 0.51, 95% CI: 0.31, 0.84, P = 0.008）。但两组骨折愈合率差异无统计学意义（OR = 1.09, 95% CI: 0.98, 1.20, P = 0.098）。结论：本研究结果提示髓内钉联合阻断螺钉可能是下肢长骨骨折患者的有效治疗选择。然而，为了证实这种疗效，需要额外的高质量研究，最好是设计良好的大样本量随机对照试验和长期随访。

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

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.