全螺纹与部分螺纹螺钉固定股骨颈骨折的荟萃分析△

A meta-analysis on full-threaded versus partial-threaded screws for femoral neck fractures

摘要:

[目的] 采用荟萃分析方法评价全螺纹螺钉 （fully threaded screws, FTS） 和部分螺纹螺钉 （partially threaded screw, PTS） 固定股骨颈骨折的疗效。[方法] 检索 PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方、维普等数据库，检索时间为 2010 年 1 月—2024 年 5 月，阅读全文提取效应量，使用 Review Manager 5.4 软件进行荟萃分析。[结果]共纳入 9 篇研究，1 篇为随机对照研究，8 篇为队列研究。共计 778 例患者，其中 FTS 固定组 342 例，PTS 固定组 436 例。荟萃分析结果显示：FTS 固定组颈干角丢失幅度 （MD=-1.57, 95%CI -2.35~-0.78, P＜0.001）、股骨颈短缩率 （OR=0.27, 95%CI 0.18~ 0.42, P＜0.001）、内固定失败率（OR=0.25, 95%CI 0.13~0.48, P＜0.001）、退钉率（OR=0.23, 95%CI 0.14~0.38, P＜0.001）均显著低于 PTS 组。两组术中出血量、手术时间、骨折愈合时间、股骨头坏死率、骨不连发生率的差异均无统计学意义（P＞0.05）。[结论] FTS 固定股骨颈骨折与 PTS 比较，患者颈干角减小幅度更小，而且退钉、股骨颈短缩、内固定失败发生率更低，对于股骨颈骨折，FTS 固定比 PTS 固定更为可靠。

Abstract:

[Objective] To compare the clinical efficacy of fully threaded screws (FTS) and partially threaded screws (PTS) for fixation of femoral neck fractures. [Methods] The data bases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang, VIP and others were searched from January 2010 to May 2024 to collect studies comparing the clinical efficacy of FTS and PTS for fixation of femoral neck fractures, and a meta-analysis was performed using Review Manager 5.4 software. [Results] Nine studies were included, involving one randomized controlled study and eight cohort studies. A total of 778 patients were enrolled, including 342 in the FTS fixed group, and 436 in the PTS fixed group. As results of meta-analysis, the FTS was significantly superior to the PTS in terms of femoral neck shortening rate (OR=0.27, 95%CI 0.18~0.42, P＜0.001), screw withdrawal rate (OR=0.23, 95%CI 0.14~0.38, P＜0.001), internal fixation failure rate (OR=0.25, 95%CI 0.13~0.48, P＜0.001), and decline of neck shaft angle (MD=-1.57, 95%CI -2.35~-0.78, P＜0.001). However, there were no significant differences between the two groups regarding to intraoperative bleeding (MD=2.45, 95%CI -6.63 ~11.54, P=0.60), operation time (MD=1.25, 95%CI -0.92~3.42, P=0.26), fracture healing time (MD=0.05, 95%CI -0.75~0.86, P=0.89), bone nonunion rate (OR=0.66, 95%CI 0.37~1.19, P=0.17), and femoral head necrosis rate (OR=0.65, 95%CI 0.32~1.31, P=0.23). [Conclusion] The FTS for internal fixation of femoral neck fractures has less loss in the femoral neck shaft angle, lower incidence of screw retraction, femoral neck shortening, and internal fixation failure than the PTS, therefore, the FTS fixation is more reliable for femoral neck fractures.