股骨近端仿生与防旋转髓内钉固定的荟萃分析△

A meta-analysis on proximal femur bionic nail versus proximal femur nail anti-rotation

摘要:

[目的] 采用荟萃分析的方法评价股骨近端仿生髓内钉（proximal femur bionic nail, PFBN） 与股骨近端防旋髓内钉（proximal femoral nail anti-rotation, PFNA） 治疗老年股骨转子间骨折临床疗效。[方法] 检索PubMed、Cochrane Library、EM-BASE、Web of Science、中国知网、万方、维普及中国生物医学文献服务系统等数据库，收集PFBN 和PFNA 治疗老年股骨转子间骨折的文献，阅读全文提取效应量，对所提数据使用RevMan 5.3 软件进行荟萃分析。[结果] 本研究共纳入文献4 篇，共236 例患者，其中PFBN 组患者118 例，PFNA 组患者118 例。PFBN 组手术时间显著长于PFNA 组（MD=0.82, 95%CI 0.08~1.55, P=0.03）。但PFBN 组在末次随访髋关节Harris 评分（MD=0.52, 95%CI 0.11~0.93, P=0.01）、负重时间（MD=-6.16, 95%CI-9.14~-3.18, P＜0.001）、骨折愈合时间（MD=-0.43, 95%CI -0.71~-0.14, P=0.003）、术后并发症发生率（OR=0.21, 95%CI 0.05~0.91, P=0.04） 均显著优于PFNA 组。两组术中出血量、住院天数的差异无统计学意义（P＞0.05）。[结论] PFBN 治疗老年股骨转子间骨折具有早期负重、骨折愈合时间短、髋关节功能恢复更好、并发症发生率更低等优势，但PFBN 比PFNA 需要更长的手术时间。

Abstract:

[Objective] To evaluate the clinical efficacy of the proximal femur bionic nail (PFBN) versus proximal femoral nail anti-ro-tation (PFNA) in the treatment of intertrochanteric fractures in elderly patients. [Methods] A comprehensive literature search was conduct-ed in databases including PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang, VIP and CBM. The search period wasfrom the inception of the databases to November 2023. Literature quality assessment and data extraction were performed independently bytwo researchers, and then RevMan 5.3 software was used for data analysis. [Results] Four studies involving a total of 236 patients, includ-ing 118 in the PFBN group and 118 in the PFNA group, were enrolled into this study. As results of the meta analysis, PFBN group had sig-nificant advantages over the PFNA group in terms of fracture healing time (MD=-0.43, 95%CI -0.71~-0.14, P=0.003), weight-bearingtime (MD=-6.16, 95%CI -9.14~-3.18, P＜0.001), final Harris score (MD=0.52, 95%CI 0.11~0.93, P=0.01), and complications (OR=0.21,95%CI 0.05~0.91, P=0.04). However, the PFBN group had a longer surgical time (MD=0.82, 95%CI 0.08~1.55, P=0.03) compared to thePFNA group. There were no statistically significant differences between the two groups in terms of intraoperative blood loss and hospitalstay. [Conclusion] The PFBN demonstrates advantages in terms of earlier weight-bearing activity, faster fracture healing, better hip func-tion recovery, and lower complications rate over the PFNA in the treatment of intertrochanteric fractures in elderly. However, PFBN re-quired longer surgical time compared to PFNA.