小児および成人に対する前腕両骨骨幹部骨折の外科的治療成績：プレート固定vs.髄内釘―メタアナリシス

Treatment of Diaphyseal Fractures of Both Forearm Bones in Children and Adults : A Meta-analysis of Plating Versus Intramedullary Pinning

　メタアナリシスで小児および成人に対する前腕両骨骨幹部骨折のプレート固定と髄内釘の手術成績を比較した．MEDLINEで検索し適格基準に合致した論文からデータを抽出した．95％信頼区間によるオッズ比を用いた．最終的に45論文が適格基準に合致した．小児に対する症例対照研究では有意な差を認めなかった．半定量研究では，小児で合併症(重度)と可動域の項目でプレート固定が劣っており，成人で可動域(高度)と変形治癒の項目で髄内釘が有意に劣っていた．小児には髄内釘，成人にはプレート固定が優れている傾向が示された．

　We compared the outcomes of plating and intramedullary pinning for diaphyseal fractures of both forearm bones by means of a meta-analysis.　A MEDLINE literature search was performed, and articles were collected according to the eligibility criteria.　Forty-five articles (6 case-control studies i　n children, 24 semi-quantitative studies in children, and 15 semi-quantitative studies in adults) were selected.　We calculated a p-value by Mantel-Haenszel method and the 95% confidence interval of the odds ratio.　In the case-control studies there tended to be more cases with severe complications among the cases treated by plating.　In the semi-quantitative studies in children there were significantly more cases with mild and severe ROM limitations and severe complications after plating.　In the semi-quantitative studies in adults there were significantly more cases of malunion and severe ROM limitation after intramedullary pinning.　Intramedullary pinning is preferable for treating diaphyseal fractures of both forearm bones in children, and plating is preferable in adults.