治疗成人前臂骺端骨折的交锁髓内钉--对结果和并发症的系统回顾和荟萃分析

IF 3 2区医学 Q1 ORTHOPEDICS

Journal of Orthopaedics and Traumatology Pub Date : 2024-04-13 DOI:10.1186/s10195-024-00761-7

Ali Lari, Yousef Hassan, Abdulwahab Altammar, Ali Esmaeil, Abdulaziz Altammar, Carlos Prada, Ali Jarragh

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引用次数: 0

摘要

本系统性综述旨在研究使用解剖交锁髓内钉（IMN）治疗成人桡骨和尺骨骨干骺端骨折的效果、并发症和潜在优势。检索了 2000 年 1 月至 2023 年 1 月期间的 Medline、Embase、Web of Science 和 Cumulative Index to Nursing and Allied Health Literature (CINAHL) 数据库。符合标准的研究均为观察性或随机对照试验，评估了 IMN 治疗成人前臂骨骺骨折的效果。研究人员进行了标准化的数据提取，并使用质量评估工具对各项研究的方法进行了评估。报告了干预措施、功能结果和并发症的描述性统计。对患者报告的结果指标和手术时间进行了 Meta 分析。共纳入了29项研究，涉及1268名患者，其中764人（60%）接受了IMN手术，21%接受了开放复位内固定术（ORIF），9%接受了混合固定术。各组间的 DASH 和 Grace-Eversmann 评分无明显差异。IMN的手术时间明显短于ORIF。DASH评分为IMN为（13.1 ± 6.04）分，ORIF为（10.17 ± 3.98）分，混合型为（15.5 ± 0.63）分。ORIF 的平均手术时间为 65.3 ± 28.7，IMN 为 50.8 ± 17.7。IMN组的并发症发生率为16.7%，ORIF组为14.9%，混合结构组为6.3%。IMN组有11例伸肌断裂。IMN组的平均前伸和上举角度分别为78.3°±7.9°和73°±5.0°。ORIF的平均前伸和后仰角度分别为82.15°±1.9°和79.7°±4.5°。与 ORIF 相比，IMN 可实现相似的功能效果和并发症发生率，且手术时间更短。IMN的应用前景广阔，但还需要更高质量的证据来评估适当的适应症、活动范围的细微差别、植入物相关并发症以及成本效益。追踪注册 PROSPERO（系统性综述国际前瞻性注册）（ID：CRD42022362353）。证据等级 III。

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Interlocking intramedullary nail for forearm diaphyseal fractures in adults—A systematic review and meta-analysis of outcomes and complications

The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace–Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353). Level of evidence III.

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来源期刊

Journal of Orthopaedics and Traumatology Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

审稿时长

13 weeks

期刊介绍： The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.