Gamma钉与滑动髋螺钉治疗股骨转子间骨折术后相关并发症的系统评价  

Postoperative implant-related complications after treatment of intertrochanteric fracture by gamma nail or by sliding hip screw： a meta-analysis

作　　者：丁晓飞[1] 裴国献[1] 李瑾[1] 吴泰相[2] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515 [2]四川大学华西医院中国循征医学中心

出　　处：《中华医学杂志》2008年第33期2364-2368,共5页National Medical Journal of China

摘　　要：目的对Gamma钉与滑动髋螺钉治疗股骨转子间骨折术后相关并发症进行评价比较。方法检索Gamma钉与滑动髋螺钉治疗股骨转子间骨折的随机对照试验。严格评价各纳入研究的质量并提取与内置物相关并发症的资料数据，采用RevMan4．2．10进行荟萃分析。结果共纳入10个随机对照试验，3个半随机对照试验。分析结果表明，Gamma钉与滑动髋螺钉比较，前者固定术后股骨干骨折发生率显著增高[RR=3．75，95％171（1．47，9．55），P=0．006]；在拉力螺钉切出率和术后总的固定并发症率方面，两者间差异无统计学意义。结论与滑动髋螺钉固定相比，Gamma钉治疗股骨转子间骨折术后发生股骨干骨折的概率更高。骨折稳定性可能影响内置物固定术后并发症的发生，有必要进行更多针对骨折稳定性分型的大样本、高质量的临床研究，以获取更充分可靠的证据。Objective To evaluate and compare the postoperative implant-related complications after treatment of intertrochanteric fracture by gamma nail or by sliding hip screw. Methods Literatures on randomized controlled trials （RCTs） of the postoperative implant-related complications after treatment of intertrochanteric fracture by gamma nail or by sliding hip screw published before the end of June 2007 were retrieved from Cochrane library, Medline, Embase databank, and Chinese Biomedical Database. Relevant articles were handsearehed in several Chinese journals. Methodology quality of the trials was critically assessed and data on postoperative implant-related complications were extracted. The software RevMan4.2. 10 provided by the Cochrane Collaboration was used for meta-analysis. Results 10 RCTs and 3 quasi-RCTs involving 1857 cases were included. The results of meta-analysis showed that gamma nailing significantly increased the rate of postoperative femoral shaft fractures [ RR = 3.75, 95% CI （ 1.47, 9.55 ）, P = 0. 006]. However, there were no statistic differences in the rates of lag screw cut-out and total mechanical complications between gamma nail and sliding hip screw treatment. Conclusion Compared with sliding hip screw for intertrochanteric fractures, gamma nailing can lead to higher incidence of postoperative femoral shaft fractures. Fracture stability may influence the rate of postoperative implant-related complications. Further large sample and high quality RCTs based on fracture stability are required in order to provide more sufficient and reliable evidence.

关 键 词：髋骨折 骨折固定术 内 术后并发症 系统评价 

分 类 号：R686[医药卫生—骨科学]