A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of femoral shaft fracture / 中国组织工程研究

ABSTRACT

BACKGROUND: A large number of studies have confirmed that expandable intramedullary nails and interlocking intramedullary nails have a good effect in repairing limb fractures. However, for the treatment of femoral shaft fractures, the advantages and disadvantages of the two kinds of fixation methods are not inconclusive. OBJECTIVE: To systematically review the safety and effectiveness of expandable intramedullary nail and interlocking intramedullary nail for treatment of femoral shaft fracture. METHODS: A computer-based online search was conducted in PubMed, Web of Science, EBSCO, The Cochrane Library, CNKI, VIP and Wanfang databases to screen the relevant clinical controlled trials of expandable intramedullary nail versus interlocking intramedullary nail for the treatment of femoral shaft fractures. Two reviewers screened the literature according to the strict inclusion criteria, and assessed the research quality of the finally included literatures, and extracted the data. Meta-analysis was performed using Stata 13. 0 software. RESULTS AND CONCLUSION: (1) A total of 7 studies (3 randomized controlled and 4 non-randomized controlled trials) were included, involving 492 patients. Expandable intramedullary nailing group contained 246 patients. Interlocking intramedullary nailing contained 246 patients. (2) The results of meta-analysis showed that compared with the interlocking intramedullary nailing group, fracture healing time, operation time, fluoroscopy time and hospital stay were shorter in the expandable intramedullary nailing group [SMD=-0. 87, 95%CI(-1. 20, -0. 54), P=0; SMD=-2. 45, 95%CI(-3. 33, -1. 58), P=0; SMD=-2. 83, 95%CI(-3. 68, -1. 97), P=0; SMD=-0. 96, 95%CI(-1. 73, -0. 18), P=0. 016]. Intraoperative blood loss was less in the expandable intramedullary nailing group than that in the interlocking intramedullary nailing group [SMD=-4. 12, 95%CI(-6. 38, -1. 87), P=0]. There was no significant difference in the rate of bone nonunion or delayed healing and the overall incidence of complications between the two groups. (3) Therefore, we theoretically believe that expandable intramedullary nailing is more advantageous than interlocking intramedullary nailing in the treatment of femoral shaft fractures, but the postoperative recovery is similar. Limited to the quality of the methodology of this study, it fails to consider the effect of the type of fracture and the interference of the field. The results need to be treated with caution, and more randomized controlled trials are needed to confirm.