股骨颈动力交叉钉系统与空心加压螺钉治疗中青年股骨颈骨折短期疗效的meta分析  

Meta-analysis of short-term efficacy between femoral neck system and cannulated compression screw for femoral neck fracture in young and middle-aged patients

作　　者：万大地 涂源源 汪群力 Wan Dadi;Tu Yuanyuan;Wang Qunli(Orthopaedic Medical Center,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou 570100,China)

机构地区：[1]中南大学湘雅医学院附属海口医院骨科医学中心,海口570208

出　　处：《中华骨科杂志》2022年第23期1595-1604,共10页Chinese Journal of Orthopaedics

摘　　要：目的探讨股骨颈动力交叉钉系统(femoral neck system,FNS)与空心加压螺钉(cannulated compression screw,CCS)治疗中青年股骨颈骨折短期疗效的差异。方法在Cochrane library、PubMed、Web of Science、Embase、中国知网、万方、维普、CBM数据库检索应用FNS或倒三角CCS治疗股骨颈骨折的所有文献,采用RevMan 5.4.1软件对数据进行meta分析。结果共纳入12篇文献,均为高质量的队列研究,合计787例股骨颈骨折手术治疗的患者,应用FNS 369例、应用CCS 418例。Meta分析结果表明:与CCS相比,FNS手术时间更短[WMD=-8.09,95%CI(-14.12,-2.06),P=0.009],术中出血量更少[WMD=6.63,95%CI(1.42,11.83),P=0.010],术后下地部分负重时间更早[WMD=-2.11,95%CI(-3.00,-1.22),P<0.001],术后完全负重时间更早[WMD=-1.01,95%CI(-1.59,-0.43),P<0.001],术后骨折愈合时间更短[SMD=-0.67,95%CI(-1.04,-0.30),P<0.001],末次随访Harris评分更高[WMD=4.67,95%CI(3.26,6.08),P<0.001],术中透视次数更少[WMD=-9.05,95%CI(-10.92,-7.18),P<0.001],术后重度股骨颈短缩率更低[RR=0.36,95%CI(0.19,0.70),P=0.002],术后并发症(泌尿系感染、静脉血栓栓塞症、骨不连、螺钉松动、股骨头坏死)发生率更低[RR=0.38,95%CI(0.27,0.53),P<0.001]。FNS与CCS术后住院时间的差异无统计学意义[WMD=0.01,95%CI(-0.36,0.39),P=0.950],骨折复位质量(Garden对线指数Ⅰ级)的差异无统计学意义[RR=1.04,95%CI(0.87,1.24),P=0.660],骨折复位质量(Garden对线指数Ⅱ级)的差异无统计学意义[RR=0.91,95%CI(0.59,1.39),P=0.650],术后中度股骨颈短缩的差异无统计学意义[RR=0.85,95%CI(0.58,1.26),P=0.430]。结论FNS治疗中青年股骨颈骨折与CCS相比手术时间更短、术中出血量更少、术后部分及完全负重时间更早、术后骨折愈合时间更短、末次随访Harris评分更高、术中透视次数更少、术后股骨颈发生重度股骨颈短缩率更低、术后并发症发生率更低。Objective To investigate the short-term efficacy difference between femoral neck system and cannulated compression screw in the treatment of femoral neck fracture in young and middle-aged patients.Methods Cochrane Library,PubMed,Web of Science,Embase,CNKI,Wanfang,VIP and CBM databases were searched.All literature on the treatment of femoral neck fractures using the femoral neck system(FNS)or cannulated compression screw(CCS).RevMan 5.4.1 software was used to analyze data.Results Twelve high-quality cohort studies were included,including 787 patients treated surgically for femoral neck fractures,of whom 369 were treated with FNS and 418 with CCS.Results of meta-analysis showed that FNS had shorter operative time than CCS for femoral neck fracture[WMD=-8.09,95%CI(-14.12,-2.06),P=0.009].FNS had less intraoperative blood loss[WMD=6.63,95%CI(1.42,11.83),P=0.010],Partial weight-bearing time of FNS was earlier postoperative[WMD=-2.11,95%CI(-3.00,-1.22),P<0.001],while full weight-bearing time was also earlier postoperative[WMD=1.01,95%CI(1.59,0.43),P<0.001),The postoperative fracture healing time of FNS was shorter[SMD=0.67,95%CI(1.04,0.30),P<0.001].The Harris score of FNS at the last follow-up was higher[WMD=4.67,95%CI(3.26,6.08),P<0.001].The number of fluoroscopy during FNS was less[WMD=-9.05,95%CI(-10.92,-7.18),P<0.001].The rate of severe femoral neck shortening after FNS was lower[RR=0.36,95%CI(0.19,0.70),P=0.002].The incidence of postoperative complications after FNS,including urinary tract infection,venous thromboembolism,bone nonunion,screw loosening,femoral head avascular necrosis,was lower[RR=0.38,95%CI(0.27,0.53),P<0.001].There was no difference in postoperative hospital stay between FNS and CCS[WMD=0.01,95%CI(-0.36,0.39),P=0.950].There was no difference in fracture reduction quality(Garden I)[RR=1.04,95%CI(0.87,1.24),P=0.660].There was no difference in fracture reduction quality(Garden II)[RR=0.91,95%CI(0.59,1.39),P=0.650].There was no difference in postoperative moderate femoral neck shortening[RR=0.85,95%CI(

关 键 词：股骨颈骨折 内固定器 骨螺丝 队列研究 META分析 

分 类 号：R687.3[医药卫生—骨科学]