股骨近端防旋髓内钉与Gamma钉固定治疗成人股骨转子间骨折的Meta分析  

Comparison between PFNA and Gamma nail in treatment of intertrochanteric fracture in adults:a meta-analysis

作　　者：焦广俊[1] 刘海春[1] 王洪亮[1] 赵华[1] 武文亮[1] 陈允震[1] 

机构地区：[1]山东大学齐鲁医院骨创科,济南250012

出　　处：《中国矫形外科杂志》2011年第22期1858-1862,共5页Orthopedic Journal of China

摘　　要：[目的]通过Meta-分析来比较股骨近端防旋髓内钉(PFNA)与Gamma钉固定治疗成人股骨转子间骨折的疗效差异。[方法]计算机检索Cochrane图书馆、MEDLINE数据库、CNKI、万方数据库、中国生物医学文献数据库,手工检索相关文献的参考文献及4种中文主要骨科杂志。收集PFNA与Gamma钉固定治疗成人股骨转子间骨折的对照研究,严格评价纳入研究的方法学质量并提取资料。统计软件采用Cochrane协作网提供的RevMan 5.0。[结果]共纳入10个对照研究,其中有2个为随机对照试验。Meta-分析显示,PFNA与Gamma钉固定比较,在术中股骨骨折、术中X线暴露次数、术后股骨骨折、切口感染、髋关节功能恢复(术后Harris评分)、骨折平均愈合时间、髋内翻、内固定移位或切出方面,两者均无统计学差异。但是PFNA固定能明显减少手术时间及术中出血量。[结论]目前尚没有足够的证据表明PFNA和Gamma钉固定治疗成人股骨转子间骨折的疗效存在统计学差异,还需要开展更多高质量、大样本的临床随机对照试验以增加证据的强度。[Objective]To assess the effects of proximal femoral nail anti-rotation（PFNA） and Gamma nail in the treatment of intertrochanteric fractures. [Method]According to Cochrane systematic review,Cochrane library,Medline,CNKI,Wanfang Data and Chinese Biomedical Database were searched for controlled trials comparing PFNA with Gamma nail in the management of intertmchanteric fractures.Furthermore,we also searched manually relevant references and Chinese orthopedic journals.Methodology quality of the trials was critically assessed and relative data were extracted.Statistical software Revman 4.2.10 was used for data-analysis. [Result]Two randomized controlled trails and eight cohort studies involving 901 cases were included.The results of meta-analysis showed that no statistically significant differences had been found in the intra-operative femoral fractures,fluoroscopy time,post-operative femoral fractures,wound infection,post-operative Harris scores,the average healing time of fractures,coxa vara and fixation migration between PFNA and Gamma nail.Compared with Gamma nail,PFNA had shorter surgical time,and less blood loss. [Conclusion]However,there is still no enough evidence to give the conclusion that there is a significant difference between PNFA and Gamma nail in treating adult femur intertrochanteric fractures.More clinical trials with a better random design and greater number of cases are needed to improve the efficacy of evidence for such a conclusion.

关 键 词：股骨转子间骨折 股骨近端防旋髓内钉(PFNA) GAMMA钉 META分析 

分 类 号：R687.3[医药卫生—骨科学]