股骨颈动力交叉钉固定股骨颈骨折的荟萃分析△

A meta-analysis on Femoral Neck System for femoral neck fractures

摘要:

［目的］ 与空心螺钉 （cannulated screws, CS） 比较，系统评价股骨颈动力交叉钉系统 （femoral neck system, FNS） 治疗股骨颈骨折的临床疗效。［方法］ 检索 PubMed、CNKI、Cochrane library、Wanfang、VIP 数据库、Embase、CBM、ChiCTR 数据库，收集 FNS 与 CS 治疗股骨颈骨折比较的文献，检索时间 2017 年 1 月—2021 年 12 月。质量评估、数据资料提取由 2 位研究者各自独立完成，使用 RevMan 5.4 软件完成荟萃分析。［结果］ 纳入 9 项回顾性队列研究，共 700 位患者。分析结果显示：FNS 治疗股骨颈骨折在手术时间 （MD=-7.11，95%CI -14.03~-0.20，P=0.04）、术中透视次数 （MD=-8.53，95%CI-10.27~-6.78，P<0.001）、骨折愈合时间 （MD=-0.72，95%CI -1.15~-0.29，P=0.001）、术后 6 个月髋关节功能评分 （MD=4.10， 95%CI 1.88~6.32，P<0.001）、股骨颈短缩率 （RR=0.63，95%CI 0.47~0.83，P=0.009） 方面均优于传统内 CS，但是 FNS 术中出血量多于 CS（MD=10.99，95%CI 4.52~17.45，P=0.009）。二者股骨头坏死率（RR=0.48, 95%CI 0.20~1.12, P=0.09）和骨不连发生率（RR=0.51，95%CI 0.21~1.24，P=0.14）的差异无统计学意义。［结论］FNS 治疗股骨颈骨折具有手术时间短、术中透视次数少、骨折愈合时间短、股骨颈短缩的发生率低、6 个月后髋关节功能恢复好等优势，临床效果显著，但术中出血量略多于 CS。

Abstract:

[Objective] To systematically evaluate the clinical efficacy of Femoral Neck System (FNS) for femoral neck fractures by comparison with cannulated screw (CS) . [Methods] The literatures on comparison of FNS and CS in the treatment of femoral neck fracture published from January 2017 to December 2021 were searched from the databases, including PubMed, CNKI, Cochrane Library, Wanfang, VIP database, Embase, CBM and ChiCTR. After quality assessment and data extraction performed independently by two researchers, the meta-analysis was performed using RevMan 5.4 software. [Results] A total of 9 retrospective cohort studies were included, involving 700 patients. As results of the meta-analysis, the FNS proved significantly superior to the CS for femoral neck fractures in terms of operation time (MD=-7.11, 95%CI -14.03~-0.20, P=0.04) , intraoperative fluoroscopy times (MD=-8.53, 95%CI -10.27~-6.78, P<0.001) , fracture healing time (MD=- 0.72, 95% CI-1.15~0.29, P=0.001) , hip function score 6 months after surgery (MD=4.10, 95% CI 1.88~6.32, P< 0.001) , femoral neck shortening rate (RR=0.63, 95%CI 0.47~0.83, P=0.009) , despite the former had greater intraoperative blood loss than the latter (MD=10.99, 95% CI 4.52~17.45, P=0.009) . However, there was no significant difference in the rate of femoral head necrosis (RR= 0.48, 95%CI 0.20~1.12, P=0.09) and the incidence of nonunion (RR=0.51, 95%CI 0.21~1.24, P=0.14) between the two groups. [Conclusion] FNS used for internal fixation of femoral neck fractures has advantages of shortening operation time, reducing intraoperative fluo- roscopy times, accelerating fracture healing, declining femoral neck shortening, and improving functional recovery, despite of the disadvan- tage of more intraoperative blood loss over the CS.