中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (53): 8677-8684.doi: 10.3969/j.issn.2095-4344.2015.53.021

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

股骨近端防旋髓内钉与锁定钢板修复股骨转子间骨折的系统评价

王 峰,李振武,尹锐锋,李志安   

  1. 南阳市中心医院,河南省南阳市 473009
  • 收稿日期:2015-10-05 出版日期:2015-12-24
  • 作者简介:王峰,男,1980年生,河南省邓州市人,汉族,2004年新乡医学院毕业,硕士,主治医师,主要从事骨与关节运动系统损伤研究。

Proximal femoral nail anti-rotation and locking plate for treating femoral intertrochanteric fractures: a systematic review

Wang Feng, Li Zhen-wu, Yin Rui-feng, Li Zhi-an   

  1. Nanyang City Center Hospital, Nanyang 473009, Henan Province, China
  • Received:2015-10-05 Online:2015-12-24
  • About author:Wang Feng, Master, Attending physician, Nanyang City Center Hospital, Nanyang 473009, Henan Province, China

摘要:

背景:临床上股骨近端锁定钢板与股骨近端防旋髓内钉是修复股骨转子间骨折的比较常见的方法,然而两者比较的随机对照研究较少,大部分都是回顾性病例分析,缺乏系统性评价。
目的:对股骨近端锁定钢板与髓内钉修复股骨转子间骨折的疗效和安全性进行系统评价。
方法:计算机检索Cochrane 图书馆(2015年第2期)、PubMed(1966年1月至2015年6月)、MEDLINE(1966年1月至2015年6月)、EMbase(1984年1月至2015年6月)、CNKI(1979年1月至2015年6月)、VIP(1989年1月至2015年6月)、WanFang Data(1990至2015年),同时手工检索相关期刊及参考文献中的相关文献。收集所有股骨近端锁定钢板与股骨近端防旋髓内钉修复股骨转子间骨折的随机对照试验,严格按照纳入标准进行文献筛选,并进行严格的文献质量评价,最后使用Cochrane协作网提供的RevMan 5.2软件对纳入的研究结果进行Meta分析。
结果与结论:共检索到相关文献54篇,最终纳入11个随机对照试验,共917例患者,其中股骨近端锁定钢板治疗组464例,股骨近端防旋髓内钉453例。Meta分析结果表明,两种治疗方式在治疗后Harris评分、治疗后优良率、治疗后并发症、骨折愈合时间及住院时间方面差异无显著性意义。而在手术时间[MD=15.80,95%CI(7.57-24.04),P=0.000 2]、失血量[MD=98.01,95%CI(58.57-137.44),P < 0.01]、下地负重时间[MD=8.07,95%CI(3.02-13.12),P=0.002]、切口长度[MD=6.90,95%CI(1.07-12.73),P=0.02]和术后引流量[MD=41.85,95%CI(23.77-59.93),P < 0.01]方面差异有显著性意义。提示相对于股骨近端防旋髓内钉而言,锁定钢板修复股骨转子间骨折所需的切口长度及手术时间较长,下地负重时间较晚,失血量和术后引流量均较多。因纳入的病例数较少,随访时间均较短,未来还需要设计更多严格的大样本随机对照研究,并进行中长期随访来增加证据的强度。 

关键词: 骨科植入物, 骨植入物, 股骨转子间骨折, 股骨近端锁定板, 股骨近端防旋髓内钉, 系统评价

Abstract:

BACKGROUND: Proximal femoral locking plate and proximal femoral nail anti-rotation are the two common methods for the treatment of femoral intertrochanteric fractures in clinic. However, there were few randomized controlled trials on the comparison of both methods. Most of them are retrospective case analysis, and short of systematic evaluation.
OBJECTIVE: To systematically evaluate the clinical outcomes and safety between locking compression plate and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures.
METHODS: The Cochrane Library (No.2 in 2015), PubMed(1966-01/2015-06), MEDLINE (1966-01/2015-06), EMbase (1984-01/2015-06), CNKI (1979-01/2015-06), VIP(1989-01/2015-06)and WanFang Data(1990-2015)were searched by computer. Meanwhile, relevant literature from the relevant journals and references were searched by hand. All the randomized controlled trials concerning locking compression plate

 

and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures were collected. The literature was strictly filtered out according to the inclusion criteria, and was strictly evaluated for the quality. Meta-analysis on the included results was performed with RevMan5.2 software from the Cochrane collaboration.
RESULTS AND CONCLUSION: There were 54 potentially relevant papers, and finally, 11 randomized controlled trials were eligible for this investigation. A total of 917 patients were included containing locking compression plate group (464 cases), proximal femoral nail anti-rotation group (453 cases). The Meta-analysis results showed that there were no significant differences in Harris scores, excellent rate, complications, fracture healing time and hospital stays after treatment between the locking compression plate and proximal femoral nail anti-rotation groups. However, there were significant differences in the time of operation [MD=15.80,95% CI(7.57-24.04), P =0.000 2], peri-operative blood loss [MD=98.01, 95% CI(58.57-137.44),P < 0.01], ambulation loading time [MD=8.07,95% CI(3.02-13.12),P=0.002], the length of incision [MD=6.90,95% CI(1.07-12.73), P=0.02] and postoperative drainage volume [MD=41.85,95% CI(23.77-59.93),P < 0.01]. These results suggest that the treatment of proximal femoral nail anti-rotation had shortened the length of incision and the time of operation. The treatment of locking compression plate took more time of ambulation loading time, more peri-operative blood loss and postoperative drainage volume. Because the number of cases which this study included are few, and the follow-up time was shorter, we should design stricter large sample randomized controlled studies in future increase the strength of the evidence by conducting medium and long-term follow-up. 

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