防旋髓内钉、动力髋螺钉及全髋关节置换修复老年股骨转子间骨折的Meta分析  

A meta-analysis of proximal femoral nail anti-rotation,dynamic hip screw and total hip arthroplasty for intertrochanteric fractures in the elderly

作　　者：乔永杰[1] 曹雪飞[1] 张吕丹 王钦鹏[3] 甄平[4] 

机构地区：[1]兰州大学第二医院骨科,甘肃省兰州市730000 [2]解放军兰州军区兰州总医院呼吸科,甘肃省兰州市730050 [3]兰州大学第二医院神经内科,甘肃省兰州市730000 [4]解放军兰州军区兰州总医院骨科,甘肃省兰州市730050

出　　处：《中国组织工程研究》2015年第31期5057-5064,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:股骨转子间骨折在治疗上选择何种方案仍存在较大争议。对于几种主流方法修复转子间骨折的疗效,已有大量的临床试验论著发表,但这些结果的评价缺乏独立性,可能存在变量及观察研究中无法测量的偏倚,因此使得相关研究进展受到了限制。目的:通过Meta分析比较防旋型股骨近端髓内钉、动力髋螺钉与人工全髋关节置换对老年股骨转子间骨折的修复效果。方法:计算机检索Cochrane图书馆、Pub Med数据库、Web of Science数据库及中国生物医学文献数据库(CBM),收集防旋型股骨近端髓内钉、动力髋螺钉与全髋关节置换修复老年股骨转子间骨折的随机对照试验,采用循证医学Meta分析方法对患者X射线曝光时间、治疗后并发症发生率、治疗后卧床时间、治疗后切口感染率、髋关节Harris评分、平均手术时间、术中出血、住院时间及手术切口长度进行综合评价。严格评价纳入标准及方法学质量并提取相关资料。统计学软件采用Cochrane协作网提供的Rev Man 5.0。结果与结论:共纳入12个随机对照试验,共包含1 454例患者。防旋型股骨近端髓内钉和动力髋螺钉内固定两种方法在平均手术时间、术中失血量、X射线曝光时间、治疗后并发症发生率、治疗后卧床时间上差异有显著性意义(P<0.05)。防旋型股骨近端髓内钉固定和全髋关节置换两种方法在住院时间、治疗后并发症发生率、治疗后卧床时间上差异有显著性意义(P<0.05)。动力髋螺钉内固定和全髋关节置换两种方法在治疗后并发症发生率、治疗后卧床时间、髋关节Harris评分上差异有显著性意义(P<0.05)。提示在手术时间、术中出血量、住院时间、治疗后并发症、治疗后卧床时间上防旋型股骨近端髓内钉明显优于动力髋螺钉和全髋关节置换,具有明显优势;在X射线曝光时间上,动力髋螺钉要优于防旋型股骨近端髓内钉;但BACKGROUND：The methods to treat intertrochanteric fracture are controversial. A large number of clinicalnbsp;studies concern the therapeutic effects of several popular methods to repair intertrochanteric fracture, but these results lack of independence, and may have bias that cannot be measured in the variable and observational studies. Thus, relevant studies have been limited. OBJECTIVE：To compare the repair effects of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty on intertrochanteric fracture in aged patients by meta-analysis. METHODS： Four electronic databases were searched, including Cochrane library, PubMed, Web of Science and Chinese BioMedical Literature Database, to colect al randomized controled trials concerning the treatment of intertrochanteric fractures in the elderly with proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty. Using meta-analysis of evidence-based medicine, X-ray exposure time, postoperative complication rate, postoperative bed time, postoperative wound infection rate, Harris hip scores, mean operation time, intraoperative blood loss, length of hospital stays and length of the incision were compared and evaluated. Standard and methodology quality of the trials were criticaly assessed and relative data were extracted. This study used the Review Manager 5.0 software provided by Cochrane colaboration network. RESULTS AND CONCLUSION：Twelve randomized controled trials with 1 454 patients were included. Significant differences in mean operation time, intraoperative blood loss, X-ray exposure time, postoperative complication rate, and postoperative bed time were detected between the proximal femoral nail anti-rotation and dynamic hip screw groups （P 〈 0.05）. Significant differences in length of hospital stays, postoperative complication rate, and postoperative bed time were observed between the proximal femoral nail anti-rotation and total hip arthroplasty groups （P 〈 0.05）. Significant differences in postop

关 键 词：植入物 骨植入物 股骨转子间骨折 防旋型股骨近端髓内钉 动力髋螺钉 全髋关节置换 META分析 

分 类 号：R318[医药卫生—生物医学工程]