4枚与3枚空心钉固定股骨颈骨折的荟萃分析△

Four versus three cannulated screws for fixation of femoral neck fractures: A meta-analysis

摘要:

[目的] 系统评价 4 枚空心钉 （4 cannulated screws, 4CS） 与 3 枚空心钉 （3 cannulated screws, 3CS） 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 4CS 和 3CS 治疗股骨颈骨折比较的文献，检索时间为自数据库建库以来到 2023 年 1 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 5.3 软件完成荟萃分析。[结果] 共纳入 5 篇文献，436 位患者，其中 4CS 组 216 例，3CS 组 220 例。荟萃分析结果显示，4CS 组在手术时间 （MD=0.93, 95%CI 0.27~1.58, P＜0.001），术中出血量 （MD=0.59, 95%CI 0.09~ 1.08, P=0.02）、术中透视次数（MD=6.53, 95%CI 5.41~7.64, P＜0.001）均显著多于 3CS 组；但是 4CS 组在术后 6 个月 Harris 评分 （MD=5.07, 95%CI 1.77~8.37, P=0.003）、骨折愈合时间（MD=-0.35, 95%CI -0.59~-0.11, P=0.004）、骨折不愈合率（OR=0.3, 95% CI 0.11~0.84, P=0.02）、股骨头坏死率 （OR=0.52, 95%CI 0.26~1.03, P=0.06）、退钉率 （OR=0.33, 95%CI 0.13~0.83, P=0.02） 均显著优于 3CS 组。两组切口长度、下地行走时间、住院天数的差异无统计学意义（P＞0.05）。[结论]4CS 治疗股骨颈骨折具有骨折愈合时间短、骨折不愈合的发生率低、术后 6 个月 Harris 评分高、退订率低等优势，临床效果显著；但 4CS 比 3CS 需要的手术时间长、术中出血量多、术中透视次数多。

Abstract:

[Objective] To systematically evaluate the clinical efficacy of 4 cannulated screws (4CS) versus 3 cannulated screws (3CS) in the treatment of femoral neck fractures. [Methods] The PubMed, CNKI, Cochrane library, Wanfang, VIP, Embase, CBM and ChiCTR da- tabase were searched to collect the literature on the comparison of 4CS and 3CS internal fixations for treatment of femoral neck fractures with retrieval time from the establishment of the database to January 2023. The quality assessment and data extraction were completed inde- pendently by two researchers, and meta-analysis was performed using RevMan 5.3 software. [Results] A total of 5 literatures with 436 pa- tients were included, involving 216 patients in the 4CS group and 220 patients in the 3CS group. As results of the meta-analysis, the 4CS group was significantly greater than the 3CS group in terms of the operative time (MD=0.93, 95%CI 0.27~1.58, P＜0.001), intraoperative blood loss (MD=0.59, 95%CI 0.09~1.08, P=0.02), intraoperative fluoroscopy (MD=6.53, 95%CI 5.41~7.64, P＜0.001). However, the 4CS group proved significantly superior to the 3CS group in terms of Harris score 6 months postoperatively (MD=5.07, 95%CI 1.77~8.37, P= 0.003), fracture healing time (MD=-0.35, 95%CI -0.59~0.11, P=0.004), and fracture nonunion rate (OR=0.3, 95%CI 0.11~0.84, P=0.02), femoral head necrosis rate (OR=0.52, 95%CI 0.26~1.03, P=0.06) and screw loosening rate (OR=0.33, 95%CI 0.13~0.83, P=0.02). There were no significant differences in incision length, postoperative walking time and hospital stay between the two groups (P＞0.05). [Conclusion] The 4CS has the advantages of short fracture healing time, low incidence of fracture nonunion, high Harris score 6 months after sur- gery, low loosening rate, and significant better clinical outcomes over the 3CS in the treatment of femoral neck fracture. However, 4CS re- quires longer operation time, more intraoperative bleeding and more intraoperative fluoroscopy than 3CS.