股骨颈系统与空心钉固定股骨颈骨折的荟萃分析△

Femoral neck system versus cannulated compression screws for femoral neck fracture: a meta- analysis

摘要:

［目的］ 系统评价股骨颈系统 （femoral neck system, FNS） 与空心加压螺钉 （cannulated compression screws, CCS） 治疗青壮年股骨颈骨折的临床疗效。［方法］检索 PubMed、Embase、Cochrane Library、中国知网、万方数据库、维普数据库建库 —2022 年 3 月有关 FNS 与 CCS 治疗股骨颈骨折的临床研究，对符合要求的文献采用 NOS 量表进行评价，提取文献数据，采用 RevMan 5.4 软件进行荟萃分析。［结果］共纳入 10 篇文献，均为回顾性队列研究，其中 324 例患者采用 FNS 治疗，374 例患者采用 CCS 治疗。荟萃分析结果显示，FNS 组术中透视次数、术后下地时间、骨折愈合时间、股骨颈短缩长度、Harris 评分结果均优于 CCS 组（P<0.05）；CCS 组术中出血量、切口长度小于 FNS 组（P<0.05）；FNS 组股骨颈短缩，内固定失效发生率均少于 CCS 组（P<0.05）。两组手术时间、住院时间、骨不连及股骨头坏死发生情况比较差异均无统计学意义（P>0.05）。［结论］ FNS 治疗青壮年股骨颈骨折与传统 CCS 比较，患者下地负重时间及骨折愈合时间更早，内固定失效率低，并且能较好维持股骨颈长度， 利于术后髋关节功能的恢复。

Abstract:

[Objective] To compare the clinical outcomes of femoral neck system versus cannulated compression screws for femoral neck fracture in young and middle- aged patients by a meta- analysis. [Methods] The electronic databases were searched before March 2022, including PubMed, Embase, Cochrane Library, Wanfang, CNKI, and VIP databases for published researches on FNS versus CCS for femoral neck fracture. RevMan 5.4 software was used to conduct meta-analysis of the data. [Results] A total of 10 articles were included into this study, involving 324 patients who had FNS used, while 374 patients who had CCS performed. As results of the meta-analysis, the FNS group proved significantly superior to the CCS group in terms of the fluoroscopy frequency, postoperative weight-bearing time, fracture heal- ing time, femoral neck shortening length, and Harris score (P＜0.05) , whereas the FNS group was significantly inferior to the CCS group in the intraoperative blood loss and incision length (P＜0.05) . In addition, the FNS group was significantly superior to the CCS group in terms of occurrence of internal fixation failure and the femoral neck shortening (P＜0.05) . However, there were no significant differences in operation time, hospital stay, incidences of nonunion and avascular necrosis of the femoral head between the two groups (P＞0.05) . [Conclusion] The FNS takes advantages of earlier postoperative weight-bearing activity, earlier fracture healing, lower incidences of femoral neck shortening and internal fixation failure over the CCS for internal fixation of femoral neck fractures in young and the middle-aged, and is beneficial to re- cover the hip functional capacity.