股骨近端防旋髓内钉、动力髋螺钉、伽马钉治疗股骨转子间骨折的系统评价  

Proximal Femoral Nails Anti-rotation, Gamma Nails and Dynamic Hip Screws in the Treatment of Intertrohanteric Fractures of Femur in Adults:A Systematic Review

作　　者：马坤龙[1] 王绚[2] 栾富均[1] 梁羽[1] 张英杰[2] 方跃[1] 屠重棋[1] 杨天府[1] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]兰州大学医学院

出　　处：《华西医学》2013年第3期345-351,共7页West China Medical Journal

摘　　要：目的评价股骨近端防旋髓内钉(PFNA)、动力髋螺钉(DHS)、伽马钉治疗股骨转子间骨折的有效性和安全性。方法计算机检索Cochrane图书馆(2011年第12期),PubMed(1966年-2011年12月),EMBASE(1974年-2011年12月),web of science(1958年-2011年12月),万方数据库(1992年-2011年12月),维普资讯网(1989年-2011年12月),中国期刊全文数据库(1994年-2011年12月),中国生物医学文献数据库(1978年-2011年12月),纳入PFNA、DHS、伽马钉治疗股骨转子间骨折的随机前瞻性研究,采取修订后的Jadad评分量表对纳入研究进行质量评价。用RevMan 5.1软件进行Meta分析。结果共纳入12个研究(1 477例患者)。Meta分析结果显示PFNA治疗股骨转子间骨折的手术时间[MD=32.19,95%CI(49.69,14.69),P=0.000 3;MD=4.52,95%CI(5.24,3.80),P<0.000 01],出血量[MD=183.06,95%CI(277.37,88.74),P=0.000 1;MD=49.49,95%CI(84.15,14.83),P=0.005]少于DHS组和伽马钉组,但是三者在总有效率、住院时间和术后并发症等方面差异无统计学意义。DHS组与伽马钉组在所有指标差异均无统计学意义。结论与DHS、伽马钉相比,PFNA可明显缩短手术时间、降低术中出血量,但并不能提高总有效率、缩短住院时间以及减少术后并发症;而DHS与伽马钉治疗股骨转子间骨折的疗效无明显差异。Objective To access the efficacy and safety of proximal femoral nail anti-rotation（PFNA）,Gamma nails and dynamic hip screws（DHS） in the treatment of intertrochanteric fractures of the femur in adults.Methods We searched the electronic database of Cochrane Library（Issue12,2011）,PubMed（1966-2011.12）,EMBASE（1974-2011.12）,web of science（1958-2011.12）,the Chinese Wanfang Literature Database（1992-2011.12）,Weipu Information Network（1989-2011.12）,China National Knowledge Infrastructure（1994-2011.12）,the Chinese Biomedical Literature（19782011.12） to include randomized prospective studies on PFNA,DHS,and Gamma nails in treating intertrochanteric fractures of the femur.RevMan 5.1 was used for Meta-analysis,and the revised Jadad scale was used to access the quality of these studies.Results Twelve studies involving 1477 cases were included.The results of Meta-analysis showed that PFNA could shorten the operation time [MD= 32.19,95%CI（49.69,14.69）,P=0.0003;MD= 4.52,95%CI（5.24,3.80）,P 0.000 01] and reduce the intraoperative blood loss [MD= 183.06,95%CI（277.37,88.74）,P=0.0001;MD= 49.49,95%CI（84.15,14.83）,P=0.005] compared with DHS and Gamma nail.But there was no statistical difference in the length of stay,total efficiency and postoperative complications among the three groups of patients.Besides,no statistical difference was found in all indicators between DHS group and the Gamma nail group.Conclusions Compared with DHS and Gamma nail,PFNA may shorten the operation time and reduce the intraoperative blood loss.However,PFNA does not improve overall efficiency,shorten the length of stay or reduce postoperative complications.In addition,there is no significant difference in treating femoral intertrochanteric fractures between DHS and Gamma nail.

关 键 词：股骨转子间骨折 股骨近端抗旋髓内钉 动力髋螺钉 伽马钉 系统评价 

分 类 号：R687.3[医药卫生—骨科学]