• 1. 新疆克拉瑪依市中心醫(yī)院骨科,克拉瑪依,8340002. 新疆克拉瑪依市中心醫(yī)院核醫(yī)學(xué)科3. 四川大學(xué)華西醫(yī)院中國(guó)循證醫(yī)學(xué)中心/臨床流行病學(xué)資源與培訓(xùn)中心(成都),成都,610041;

目的 　對(duì)擴(kuò)髓與非擴(kuò)髓髓內(nèi)釘固定治療股骨干骨折的療效進(jìn)行系統(tǒng)評(píng)價(jià).
方法 　計(jì)算機(jī)檢索MEDLINE(1966～2004.5)、EMBASE(1966～2004.5)、Cochrane圖書館(2004年第2期)、Cochrane協(xié)作網(wǎng)肌骨創(chuàng)傷組試驗(yàn)數(shù)據(jù)庫(kù)(2004.5)和中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(1979～2004.5),手工檢索 lt;中華骨科雜志 gt;(創(chuàng)刊～2004.5)和 lt;中華創(chuàng)傷骨科雜志 gt;(創(chuàng)刊～2004.5),收集所有相關(guān)隨機(jī)對(duì)照試驗(yàn)及半隨機(jī)對(duì)照試驗(yàn),并采用RevMan 4.2.3進(jìn)行Meta分析.
結(jié)果 　共納入5個(gè)隨機(jī)對(duì)照試驗(yàn),2個(gè)半隨機(jī)對(duì)照試驗(yàn).Meta分析顯示,與非擴(kuò)髓髓內(nèi)釘固定相比,擴(kuò)髓髓內(nèi)釘固定能降低股骨干骨折的不愈合率[RR=0.38,95%CI(0.17,0.83),P=0.01]和內(nèi)固定失效率[RR=0.42,95%CI(0.20,0.89),P=0.02].
結(jié)論 　與非擴(kuò)髓髓內(nèi)釘固定相比,擴(kuò)髓髓內(nèi)釘固定能降低股骨干骨折的不愈合率及內(nèi)固定失效率.但擴(kuò)髓與否與肺部并發(fā)癥、骨折愈合時(shí)間、感染、畸形愈合的發(fā)生及手術(shù)時(shí)間、失血量等的關(guān)系,以及骨折開放與否、是否合并多發(fā)傷、及骨折的部位等對(duì)上述指標(biāo)的影響有待于進(jìn)一步研究.

引用本文： 廖燚,王新玲,吳泰相. 擴(kuò)髓與非擴(kuò)髓髓內(nèi)釘固定治療股骨干骨折的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(9): 620-626. doi: 復(fù)制

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1. ［1］Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed[J]. J Am Acad Orthop Surg, 2000; 8(2): 83-90.
2. ［2］Debrauwer S, Hendrix K, Verdonk R. Anterograde femoral nailing with a reamed interlocking titanium alloy nail[J]. Acta Orthop Belg, 2000; 66(5): 484-489.
3. ［3］Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures[J]. J Orthop trauma, 2001; 15(1): 28-32.
4. ［4］Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003][M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, Issue 1.
5. ［5］Anonymous. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial[J]. J Bone Joint Surg Am, 2003; 85(11): 2 093-2 096.
6. ［6］Tornetta P 3rd, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing[J]. J Orthop Trauma, 2000; 14(1): 15-19.
7. ［7］Clatworthy MG, Clark DI, Gray DH, Hardy AE. Reamed versus unreamed femoral nails. A randomised, prospective trial[J]. J Bone Joint Surg Br, 1998; 80(3): 485-489.
8. ［8］Powell J, DeGroote R, Buckley R, Feibel R, Leighton R, McCormack R, McKee M, Schemitsch EH. A prospective randomised clinical trial comparing reamed vs unreamed intramedullary nailing of femoral shaft fractures: an assessment of pulmonary dysfunction[J]. J Bone Joint Surg Br, 2000; 82 (Suppl 2): 148-149.
9. ［9］Bone LB, Kowalski J, Rohrbacher B, Stegemann P. Reamed versus unreamed femoral nailing: a prospective randomized study[C]. Presented at the 12th Annual Meeting of the Orthopaedic Trauma Association, Boston, Massachusetts, 1996.
10. ［10］Selvakumar K, Saw KY, Fathima M. Comparison study between reamed and unreamed nailing of closed femoral fractures[J]. Med J Malaysia, 2001; 56 Suppl D: 24-28.
11. ［11］Tuzuner T, Subasi M, Kapukaya A, Necmioglu NS. Treatment of femoral shaft fractures with interlocking intramedullary nailing[J]. Acta Orthop Traumatol Turc, 2002; 36(3): 211-219.
12. ［12］Arazi M, Ogun TC, Oktar MN, Memik R, Kutlu A. Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure[J]? J Trauma, 2001; 50(4): 711-716.
13. ［13］Reichert ILH, McCarthy ID, Hughes SPF. The acute vascular response to intramedullary nailing: microsphere estimation of blood flow in the intact ovine tibia[J]. J Bone Joint Surg Br, 1995; 77-B(3): 490-493.
14. ［14］Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SG. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis[J]. J Orthop Trauma, 2000; 14(1): 2-9.
15. ［15］Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail[J]. J Bone Joint Surg Am, 1999; 81(11): 1 538-1 544.
16. ［16］Hulth A. Current concepts of fracture healing[J]. Clin Orthop, 1989; (249): 265-284.
17. ［17］Zhang YM, Liang GH, Feng GP, Chen ZY. The effect of reaming on intramedullary pressure and pulmonary fat embolization[J]. Chin J Orthop, 1999; 19(8): 494-497.
18. 張毅敏, 梁國(guó)穗, 馮國(guó)培, 陳振宇. 擴(kuò)髓對(duì)髓內(nèi)壓和肺部脂肪栓塞的影響[J]. 中華骨科雜志, 1999; 19(8): 494～497.
19. ［18］Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing demonstrated by intraoperative echocardiography[J]. Injury, 1993; 24 (Suppl 3): 73-81.
20. ［19］Pape H, Regel G, Dwenger A, Sturm J, Tscherne H. Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients[J]. Injury, 1993; 24 (Suppl 3): 82-103.
21. ［20］Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma[J]. J Trauma, 1993; 35(5): 709-716.
22. ［21］Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R. Transcardiac echocardiography during invasive intramedullary procedures[J]. J Bone Joint Surg Br, 1995; 77(3): 450-455.
23. ［22］Charash WE, Fabian TC, Croce M. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma[J]. J Trauma, 1994; 37(4): 667-672.
24. ［23］Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilisation of fractures: a prospective randomized study[J]. J Bone Joint Surg Am, 1989; 71(3): 336-340.
25. ［24］Helttula I, Karanko M, Gullichsen E. Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures[J]. J Trauma, 2000; 48(4): 704-710.
26. ［25］Liu SJ, Li FB, Chen LY, Pan T, Peng XS. The influence of reamed and unreamed femoral intramedullary nailing on function of pulmonary gas exchange[J]. Orthop J Chin, 2003; 11(1): 27-29.
27. 劉世敬, 李佛保, 陳立言, 潘滔, 彭新生. 股骨干骨折擴(kuò)髓與不擴(kuò)髓固定對(duì)肺氣體交換功能的影響[J]. 中國(guó)矯形外科雜志, 2003; 11(1): 27～29.
  1. 1. ［1］Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed[J]. J Am Acad Orthop Surg, 2000; 8(2): 83-90.
  2. 2. ［2］Debrauwer S, Hendrix K, Verdonk R. Anterograde femoral nailing with a reamed interlocking titanium alloy nail[J]. Acta Orthop Belg, 2000; 66(5): 484-489.
  3. 3. ［3］Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures[J]. J Orthop trauma, 2001; 15(1): 28-32.
  4. 4. ［4］Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003][M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, Issue 1.
  5. 5. ［5］Anonymous. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial[J]. J Bone Joint Surg Am, 2003; 85(11): 2 093-2 096.
  6. 6. ［6］Tornetta P 3rd, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing[J]. J Orthop Trauma, 2000; 14(1): 15-19.
  7. 7. ［7］Clatworthy MG, Clark DI, Gray DH, Hardy AE. Reamed versus unreamed femoral nails. A randomised, prospective trial[J]. J Bone Joint Surg Br, 1998; 80(3): 485-489.
  8. 8. ［8］Powell J, DeGroote R, Buckley R, Feibel R, Leighton R, McCormack R, McKee M, Schemitsch EH. A prospective randomised clinical trial comparing reamed vs unreamed intramedullary nailing of femoral shaft fractures: an assessment of pulmonary dysfunction[J]. J Bone Joint Surg Br, 2000; 82 (Suppl 2): 148-149.
  9. 9. ［9］Bone LB, Kowalski J, Rohrbacher B, Stegemann P. Reamed versus unreamed femoral nailing: a prospective randomized study[C]. Presented at the 12th Annual Meeting of the Orthopaedic Trauma Association, Boston, Massachusetts, 1996.
  10. 10. ［10］Selvakumar K, Saw KY, Fathima M. Comparison study between reamed and unreamed nailing of closed femoral fractures[J]. Med J Malaysia, 2001; 56 Suppl D: 24-28.
  11. 11. ［11］Tuzuner T, Subasi M, Kapukaya A, Necmioglu NS. Treatment of femoral shaft fractures with interlocking intramedullary nailing[J]. Acta Orthop Traumatol Turc, 2002; 36(3): 211-219.
  12. 12. ［12］Arazi M, Ogun TC, Oktar MN, Memik R, Kutlu A. Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure[J]? J Trauma, 2001; 50(4): 711-716.
  13. 13. ［13］Reichert ILH, McCarthy ID, Hughes SPF. The acute vascular response to intramedullary nailing: microsphere estimation of blood flow in the intact ovine tibia[J]. J Bone Joint Surg Br, 1995; 77-B(3): 490-493.
  14. 14. ［14］Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SG. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis[J]. J Orthop Trauma, 2000; 14(1): 2-9.
  15. 15. ［15］Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail[J]. J Bone Joint Surg Am, 1999; 81(11): 1 538-1 544.
  16. 16. ［16］Hulth A. Current concepts of fracture healing[J]. Clin Orthop, 1989; (249): 265-284.
  17. 17. ［17］Zhang YM, Liang GH, Feng GP, Chen ZY. The effect of reaming on intramedullary pressure and pulmonary fat embolization[J]. Chin J Orthop, 1999; 19(8): 494-497.
  18. 18. 張毅敏, 梁國(guó)穗, 馮國(guó)培, 陳振宇. 擴(kuò)髓對(duì)髓內(nèi)壓和肺部脂肪栓塞的影響[J]. 中華骨科雜志, 1999; 19(8): 494～497.
  19. 19. ［18］Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing demonstrated by intraoperative echocardiography[J]. Injury, 1993; 24 (Suppl 3): 73-81.
  20. 20. ［19］Pape H, Regel G, Dwenger A, Sturm J, Tscherne H. Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients[J]. Injury, 1993; 24 (Suppl 3): 82-103.
  21. 21. ［20］Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma[J]. J Trauma, 1993; 35(5): 709-716.
  22. 22. ［21］Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R. Transcardiac echocardiography during invasive intramedullary procedures[J]. J Bone Joint Surg Br, 1995; 77(3): 450-455.
  23. 23. ［22］Charash WE, Fabian TC, Croce M. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma[J]. J Trauma, 1994; 37(4): 667-672.
  24. 24. ［23］Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilisation of fractures: a prospective randomized study[J]. J Bone Joint Surg Am, 1989; 71(3): 336-340.
  25. 25. ［24］Helttula I, Karanko M, Gullichsen E. Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures[J]. J Trauma, 2000; 48(4): 704-710.
  26. 26. ［25］Liu SJ, Li FB, Chen LY, Pan T, Peng XS. The influence of reamed and unreamed femoral intramedullary nailing on function of pulmonary gas exchange[J]. Orthop J Chin, 2003; 11(1): 27-29.
  27. 27. 劉世敬, 李佛保, 陳立言, 潘滔, 彭新生. 股骨干骨折擴(kuò)髓與不擴(kuò)髓固定對(duì)肺氣體交換功能的影響[J]. 中國(guó)矯形外科雜志, 2003; 11(1): 27～29.