摘要
目的系统评价股骨颈动力交叉钉系统(FNS)对比空心加压螺钉(CCS)和动力髋螺钉(DHS)治疗股骨颈骨折的临床疗效。方法检索中国知网、万方、维普、中国生物医学文献、PubMed、荷兰医学文摘(Embase)、Cochrane循证医学图书馆(Cochrane Library)数据库中有关FNS对比CCS或DHS治疗股骨颈骨折的临床研究,纳入的研究类型包括随机对照研究、队列研究、病例对照研究,其中研究对象为≥18岁的新鲜股骨颈骨折患者;排除计算机辅助下置钉或者生物力学相关的研究;检索时限从建库至2022年8月10日。由2名研究者独立筛选文献、提取资料并评估研究质量后,应用RevMan 5.4软件进行Meta分析。结果纳入25项高质量队列研究,共1884例患者。Meta分析结果显示,与CCS相比,FNS骨折愈合时间更短[标准化均数差(SMD)=-0.68,95%置信区间(CI)(-1.00,-0.36),P<0.0001]、Harris评分更高[均数差(MD)=2.46,95%CI(1.14,3.78),P=0.0003]、透视次数更少[MD=-10.61,95%CI(-12.64,-8.58),P<0.0001]、发生股骨颈短缩[MD=-2.23,95%CI(-3.66,-0.99),P=0.0007]、股骨头坏死[比值比(OR)=0.54,95%CI(0.31,0.96),P=0.04]、螺钉切出[OR=0.33,95%CI(0.17,0.67),P=0.002]、退钉[OR=033,95%CI(0.17,0.62),P=0.0007]的风险更低,而出血量增加[SMD=0.90,95%CI(0.51,1.28),P<0.0001],两组手术时间、VAS评分、骨折不愈合发生率的差异无统计学意义(均为P>0.05)。与DHS相比,FNS具有更少的手术时间[MD=-23.72,95%CI(-30.21,-17.22),P<0.0001]、透视次数[MD=-10.33,95%CI(-11.71,-8.95),P<0.0001]和出血量[SMD=-0.51,95%CI(-0.90,-0.12),P<0.01],两组Harris评分、股骨颈短缩、骨折不愈合、螺钉切出、退钉发生率差异无统计学意义(均为P>0.05)。结论FNS治疗股骨颈骨折在骨折愈合时间、Harris评分、透视次数、以及股骨颈短缩、股骨头坏死、螺钉切出、退钉发生率方面优于CCS,而比较FNS和DHS的研究数量太少,需要更多高质量研究才能得出较明确的结论。
Objective To systematically evaluate clinical efficacy of femoral neck system(FNS)compared with cannulated compression screw(CCS)and dynamic hip screw(DHS)in the treatment of femoral neck fracture.Methods Clinical studies using FNS versus CCS or DHS in the treatment of femoral neck fractures were searched fromChina National Knowledge Infrastructure(CNKI),Wanfang database,China Science and Technology Journal Database(VIP),Chinese Biomedical Literature,PubMed,Excerpta Medica Database(Embase)and Cochrane Library.The enrolled studies included randomized controlled trials,cohort,and case-control studies,in which the participants were fresh femoral neck fracture patients over 18 years old;the studies related to computer assisted nail placement or biomechanics were excluded.The search period was from the establishment of the database to August 10,2022.After literature screening,data extraction and study quality assessment by two researchers,meta-analysis was performed using RevMan 5.4 software.Results A total of 1884 patients were enrolled in 25 high-quality cohort studies.This meta-analysis revealed that compared with CCS,FNS fixation had shorter fracture healing time[standardized mean difference(SMD)=-0.68,95%confidence interval(CI)(-1.00,-0.36),P<0.0001],better Harris score[mean difference(MD)=2.46,95%CI(1.14,3.78),P=0.0003],fewer fluoroscopies[MD=-10.61,95%CI(-12.64,-8.58),P<0.0001],lesser femoral neck shortening[MD=-2.23,95%CI(-3.66,-0.99),P=0.0007],lower number of femoral head necrosis[odds ratio(OR)=0.54,95%CI(0.31,0.96),P=0.04],lower number of screw cutout[OR=0.33,95%CI(0.17,0.67),P=0.002],and lesser extent of nail retreat[OR=033,95%CI(0.17,0.62),P=0.0007],but more blood loss[SMD=0.90,95%CI(0.51,1.28),P<0.0001],and there was no statistically difference in terms of operation time,VAS score and incidence of nonunion(all P>0.05).Meanwhile,compared with DHS,FNS had lesser operative time[MD=-23.72,95%CI(-30.21,-17.22),P<0.0001],fewer fluoroscopies[MD=-10.33,95%CI(-11.71,-8.95),P<0.0001],and lesser blood loss[SMD=-0.5
作者
欧梁
齐麒
胡伟伟
卢敏
黄彦昌
黄维琛
匡建军
Ou Liang;Qi Qi;Hu Weiwei;Lu Min;Huang Yanchang;Huang Weichen;Kuang Jianjun(Hunan Academy of Chinese Medicine,Changsha 410006,China;Hunan University of Chinese Medicine,Changsha 410208,China;Department of Orthopedics,The Second Affiliated Hospital of Guizhou University of Chinese Medicine,Guiyang 550003,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2024年第1期92-105,共14页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
长沙市科技局科技创新平台项目(kh2201063)
关键词
股骨颈骨折
骨折固定术
内
骨钉
髋骨折
Meta分析
Femoral neck fractures
Internal fixation,internal
Bone nails
Hip fractures
Meta-analysis
