股骨转子间骨折内固定失败因素的荟萃分析

A meta-analysis on failure of proximal femoral nail anti-rotation for femoral intertrochanteric fractures

摘要:

[目的]采用荟萃分析评价股骨转子间骨折股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)内固定术后失败的因素。[方法]计算机检索中国知网(CNKI)、万方、Pubmed 等数据库相关文献并提取数据，采用 Review Manager 5.3 软件进行荟萃分析。[结果]共纳入 14 篇文献，其中中文文献 11 篇，英文文献 3 篇，均为回顾性病例对照研究。所有患者均采用 PFNA 内固定治疗，共 2 477 例，内固定术后失败共 333 例，所有病例术后随访至少 6 个月。影响 PFNA 内固定术后失败的影响因素包括，骨折稳定性 (OR=20.94，95% CI：13.45~32.61，P＜0.001)、骨折复位质量 (OR=9.68，95% CI：4.85~19.3， P＜0.001)、尖顶距 (OR=3.98，95% CI：2.71~5.84，P＜0.001)、骨质疏松 (OR=2.88, 95% CI：2.01~4.15，P＜0.001)、外侧壁完整性 (OR=5.40，95% CI：3.36~8.70，P＜0.001)、合并内科疾病 (OR=3.10，95% CI：1.75~5.49，P＜0.001)、唑来膦酸使用 (OR=0.47，95% CI：0.26~0.85，P=0.01)。[结论]骨折稳定性、骨折复位质量、尖顶距、骨质疏松、外侧壁完整性和合并内科疾病是 PFNA 内固定术后失败的危险因素，而唑来膦酸的使用为保护性因素。

Abstract:

[Objective] To evaluate the factors related to proximal femoral nail anti-rotation (PFNA) failure for internal fixation of inter- trochanteric fractures by meta-analysis. [Methods] Relevant literatures were retrieved from CNKI, Wanfang, Pubmed and other databases, and the data were extracted. Review Manager 5.3 software was used for meta-analysis. [Results] A total of 14 literatures were included, in- cluding 11 papers in Chinese and 3 in English, which all were retrospective case-control studies. All patients (2 477 cases) in the litera- tures were treated with PFNA, and followed up for 6 months at least, and 333 patients of them proved of internal fixation failed. The factors related to postoperative failure of PFNA were as follows: fracture stability (OR=20.94, 95% CI: 13.45~32.61, P＜0.001) , fracture reduction quality (OR=9.68, 95%CI: 4.85~19.3, P＜0.001) , tip-apex distance (OR=3.98, 95%CI: 2.71~5.84, P＜0.001) , osteoporosis (OR=2.88, 95% CI: 2.01~4.15, P＜0.001) , lateral wall integrity (OR=5.40, 95% CI: 3.36~8.70, P＜0.001) , complicated with medical diseases (OR=3.10, 95%CI: 1.75~5.49, P＜0.001) , the zoledronate used (OR=0.47, 95% CI: 0.26~0.85, P=0.01) . [Conclusion] Fracture stability, fracture re- duction quality, tip-apex distance, osteoporosis, lateral wall integrity and associated medical diseases are the risk factors for PFNA failure, whereas using zoledronate is a protective factor.