股骨粗隆间骨折髓内钉远端是否锁定的荟萃分析△

Distal locked or unlocked cephalomedullary nail in the treatment of intertrochanteric fracture: A meta analysis

摘要:

[目的]系统评价髓内钉远端锁定与非锁定治疗股骨转子间骨折的临床疗效及安全性。[方法]检索 2022 年 10 月以前收录在 Pubmed、Embase、Cochrane、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中髓内钉远端锁定与远端非锁定治疗股骨转子间骨折的临床研究。根据纳入和排除标准，进行文献筛查、数据提取并评价其方法学质量，采用 Rev- Man5.3 软件进行荟萃分析。[结果] 最终纳入 9 篇文献，共 1 977 例转子间骨折的患者，其中锁定组 830 例，非锁定组 1 147 例。荟萃分析结果显示：非锁定组的手术时间 （MD=7.5, 95%CI 5.0~10.1, P＜0.001）、术中出血量 （MD=37.6, 95%CI 20.1~55.2, P＜0.001），透视时间 （MD=6.8, 95%CI 4.4~9.2, P＜0.001），切口总长度 （MD=2.5, 95%CI 2.1~2.9, P＜0.001） 均显著优于锁定组。 非锁定组的术后大腿疼痛发生率显著低于锁定组（RR=4.7, 95%CI 2.4~9.2, P＜0.001）。两组在骨折延迟愈合、髋部疼痛、伤口感染、近端螺钉切出、髓内钉周围骨折并发症发生率差异均无统计学意义 （P＞0.05）。两组末次随访时 Harris 评分的差异无统计学意义 （P＞0.05）。[结论] 对于 31A1+A2 型股骨转子间骨折，髓内钉远端不锁定可以在保证关节功能的同时降低术中伤害， 降低术后大腿疼痛发生率。

Abstract:

[Objective] To compare the clinical efficacy between distal locked and unlocked intramedullary nailing in the treatment of femoral intertrochanteric fracture. [Method] The data bases, such as China National Knowledge Infrastructure (CNKI), Wanfang database, VIP database, China Biological Literature system (CBM), PubMed, Embase, and Cochrane library were searched for the comparison of clini- cal outcomes of distal locked versus unlocked intramedullary nailing in the treatment of intertrochanteric fracture from the creating to Octo- ber 2022. Literature screening, quality assessment, and data extraction were conducted to meet the inclusion and exclusion criteria, and Rev-Man 5.3 was used to perform the meta-analysis of parameters related to the consequences. [Results] A total of 9 studies were included with 1 977 patients treated with intramedullary nail fixation for femoral intertrochanteric fractures, including 830 cases in the distal locked group and 1 147 cases in the distal unlocked group. As results of the meta-analysis, the unlocked group proved significantly superior to the locked group in terms of operation time (MD=7.5, 95%CI 5.0~10.1, P＜0.001), intraoperative bleeding (MD=37.6, 95%CI 20.1~55.2, P＜ 0.001), fluoroscopy times (MD=6.8, 95%CI 4.4~9.2, P＜0.001） and total incision length (MD=2.5, 95%CI 2.1~2.9, P＜0.001), whereas the unlocked group had significantly lower incidence of postoperative thigh pain than the locked group (RR=4.7, 95%CI 2.4~9.2, P＜0.001). However, there was no significant difference in complications, such as delayed fracture healing, hip pain, wound infection, screw cutting, peri-implant fractures between the two groups (P＞0.05). In addition, there was no significant difference in Harris score between the two groups at the last follow-up (P＞0.05). [Conclusion] For femoral intertrochanteric fractures (31A1+A2), the distal unlocked intramedullary nails can ensure stable fixation, while reducing intraoperative injury and reducing the incidence of postoperative thigh pain.