系统回顾肱骨中轴骨折的手术治疗：顺行与逆行髓内钉

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-14 DOI:10.1016/j.jcot.2025.103039

Idrees Ahmed , Nicholas Aresti

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引用次数: 0

摘要

目的：本系统综述和荟萃分析的目的是确定哪种髓内钉技术（顺行或逆行）与肱骨骨干骨折治疗中较好的手术和/或功能结果相关。方法该药物已在国际前瞻性系统评价注册（PROSPERO）注册（CRD42022373170）。用于进行文献检索的数据库为Pubmed/Medline、Embase、Web of Science。对所有纳入研究的参考文献进行筛选，以确定在初始数据库检索中未找到的论文。纳入标准为;肱骨干骨折髓内钉治疗，直接比较顺行和逆行技术，参与者年龄在16岁及以上，并报道了感兴趣的结果。排除标准包括病理性肱骨骨折、肱骨干骨折延迟、畸形或不愈合的手术处理以及随访时间小于3个月的研究。结果本综述包括三项研究，共分析了216例患者。唯一有意义的手术结果是手术时间（分钟）发现顺行钉入组明显更短。叙述性综合提示顺行髓内钉与肩部症状的关系大于逆行髓内钉与肘部症状的关系。偏倚风险分析发现，所有纳入的三项研究均为中等偏倚风险。结论没有足够的证据表明顺行或逆行髓内钉治疗肱骨干骨折的手术效果或功能效果更好。需要足够有力的多中心研究来确定顺行和逆行肱骨髓内钉的循证优点和缺点。证据水平1 -系统评价和荟萃分析。

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A systematic review of the surgical management of mid-shaft humeral fractures: Antegrade versus Retrograde Intramedullary nailing

Aims

The aim of this systematic review and meta-analysis was to establish which intramedullary nailing technique, antegrade or retrograde, was associated with superior operative and/or functional outcomes in the treatment of humeral shaft fractures.

Methods

This SR was registered on the international prospective register of systematic reviews (PROSPERO) (CRD42022373170). The databases used to conduct the search for literature were Pubmed/Medline, Embase, Web of Science. References of all included studies were screened to identify papers not found in the initial database search.

The inclusion criteria were; humeral shaft fractures treated with intramedullary nailing, direct comparison of antegrade and retrograde techniques, participants aged 16 and over, and outcomes of interest being reported. Exclusion criteria included pathological humerus fractures, humeral shaft fracture operative management for delayed, mal or non-union and studies with follow up time of less than 3 months.

Results

This review included three studies resulting in the analysis of 216 patients in total. The only significant surgical outcome was that surgical time (minutes) was found to be significantly shorter for the antegrade nailing group. The narrative synthesis suggested that antegrade nailing is associated with shoulder symptoms to a greater degree than retrograde nailing is for elbow symptoms. Risk of bias analysis found that all three included studies were at moderate risk of bias.

Conclusions

There is not enough evidence to suggest whether antegrade or retrograde nailing results in better surgical or functional outcomes in the treatment of humeral shaft fractures. Sufficiently powered multicentre studies will be required to identify evidence-based advantages and disadvantages of both antegrade and retrograde intramedullary humeral nailing.

Level of evidence

1 - systematic review and meta-analysis.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.