摘要
目的系统评价术中局部应用富血小板血浆治疗股骨颈骨折的有效性和安全性。方法计算机检索The Cochrane Library、EMbase、PubMed、Web of Science、WanFang Data、CBM和CNKI数据库,搜集内固定手术联合局部应用富血小板血浆治疗成人股骨颈骨折的随机对照试验,检索时限均从建库至2019年4月30日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入8个随机对照试验(RCT),916例股骨颈骨折患者。Meta分析结果显示:与单纯内固定手术组相比,内固定手术联合富血小板血浆组可明显缩短骨折愈合时间[MD=-2.18,95%CI(-3.37,-0.99),P=0.000 3],提高骨折愈合率[RR=1.14,95%CI(1.03,1.25),P<0.000 01],改善术后髋关节功能评分[MD=10.18,95%CI(5.99,14.37),P<0.000 01],降低术后股骨头坏死发生率[RR=0.35,95%CI(0.22,0.57),P<0.000 1]。结论现有证据表明,相比于单独内固定术,内固定手术联合术中局部应用富血小板血浆可有效提高股骨颈骨折愈合率及改善术后髋关节功能,缩短骨折愈合时间,降低术后股骨头坏死发生率。但受纳入研究数量和质量的限制,上述结论还需更多高质量研究予以证实。
Objectives To systematically review the safety and efficacy of intraoperative local application of platelet-rich plasma in patients with femoral neck fracture. Methods Databases including The Cochrane Library,PubMed, Web of Science, WanFang Data, CBM, EMbase and CNKI were searched to collect randomized controlled trials(RCTs) on operation versus operation combined with platelet-rich plasma for patients with femoral neck fracture from inception to April 30 th, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. Results A total of 8 RCTs, including 916 patients with femoral neck fracture were enrolled in the analysis. The results of meta-analysis showed that compared with the group of internal fixation, the group of internal fixation combined with platelet-rich plasma could significantly shorten healing duration of fracture(MD=-2.18, 95%CI-3.37 to -0.99, P=0.000 3), improve the fracture healing rate(RR=1.14,95%CI 1.03 to 1.25, P<0.000 01) and hip function score(MD=10.18, 95%CI 5.99 to 14.37, P<0.000 01), and effectively reduce the femoral head necrosis rate after operation(RR=0.35, 95%CI 0.22 to 0.57, P<0.000 1). Conclusion Current evidence shows that the method of internal fixation combined with platelet-rich plasma could effectively shorten healing duration, improve healing rate and hip function score, and reduce the rate of femoral head necrosis. Due to the limited quality of the included studies, more large scale, high-quality studies are required to verify the above conclusion.
作者
邢飞
段鑫
陈家磊
刘明
XING Fei;DUAN Xin;CHEN Jialei;LIU Ming(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2019年第12期1453-1459,共7页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金项目（编号：31870961、81401813、81501879）
中德科学中心基金项目（编号：GZ1219）
关键词
股骨颈骨折
内固定
空心钉
富血小板血浆
随机对照试验
Femoral neck fracture
Internal fixation
Cannulated screw
Platelet-rich plasma
Randomized controlled trial
