4枚与3枚空心钉固定股骨颈骨折的荟萃分析  

Four versus three cannulated screws for fixation of femoral neck fractures:A meta-analysis

作　　者：段文禹 焦录 马云强 周东明[2] DUAN Wen-yu;JIAO Lu;MA Yun-qiang;ZHOU Dong-ming(Baotou Medical College,Baotou 014040,China;The First Affiliated Hospital,Baotou Medical College,Baotou 014017,China)

机构地区：[1]包头医学院,内蒙古包头014040 [2]包头医学院第一附属医院,内蒙古包头014017

出　　处：《中国矫形外科杂志》2023年第20期1860-1864,共5页Orthopedic Journal of China

基　　金：内蒙古自治区高等学校科学研究项目(编号:NJZY21067);内蒙古自治区研究生科研创新项目(编号:S20210175Z);包头医学院青年科技及人才发展计划项目(编号:BYJJ-DXK 202207)。

摘　　要：[目的]系统评价4枚空心钉(4 cannulated screws,4CS)与3枚空心钉(3 cannulated screws,3CS)治疗股骨颈骨折的临床疗效。[方法]检索PubMed、CNKI、Cochrane library、Wanfang、VIP数据库、Embase、CBM、ChiCTR数据库,收集4CS和3CS治疗股骨颈骨折比较的文献,检索时间为自数据库建库以来到2023年1月。质量评估、数据资料提取由2位研究者各自独立完成,使用RevMan 5.3软件完成荟萃分析。[结果]共纳入5篇文献,436位患者,其中4CS组216例,3CS组220例。荟萃分析结果显示,4CS组在手术时间(MD=0.93,95%CI 0.27~1.58,P<0.001),术中出血量(MD=0.59,95%CI 0.09~1.08,P=0.02)、术中透视次数(MD=6.53,95%CI 5.41~7.64,P<0.001)均显著多于3CS组;但是4CS组在术后6个月Harris评分(MD=5.07,95%CI 1.77~8.37,P=0.003)、骨折愈合时间(MD=-0.35,95%CI-0.59~-0.11,P=0.004)、骨折不愈合率(OR=0.3,95%CI 0.11~0.84,P=0.02)、股骨头坏死率(OR=0.52,95%CI 0.26~1.03,P=0.06)、退钉率(OR=0.33,95%CI 0.13~0.83,P=0.02)均显著优于3CS组。两组切口长度、下地行走时间、住院天数的差异无统计学意义(P>0.05)。[结论]4CS治疗股骨颈骨折具有骨折愈合时间短、骨折不愈合的发生率低、术后6个月Harris评分高、退订率低等优势,临床效果显著;但4CS比3CS需要的手术时间长、术中出血量多、术中透视次数多。[Objective]To systematically evaluate the clinical efficacy of 4 cannulated screws(4CS)versus 3 cannulated screws(3CS)in the treatment of femoral neck fractures.[Methods]The PubMed,CNKI,Cochrane library,Wanfang,VIP,Embase,CBM and ChiCTR da-tabase were searched to collect the literature on the comparison of 4CS and 3CS internal fixations for treatment of femoral neck fractures with retrieval time from the establishment of the database to January 2023.The quality assessment and data extraction were completed inde-pendently by two researchers,and meta-analysis was performed using RevMan 5.3 software.[Results]A total of 5 literatures with 436 pa-tients were included,involving 216 patients in the 4CS group and 220 patients in the 3CS group.As results of the meta-analysis,the 4CS group was significantly greater than the 3CS group in terms of the operative time(MD=0.93,95%CI 0.27~1.58,P<0.001),intraoperative blood loss(MD=0.59,95%CI 0.09~1.08,P=0.02),intraoperative fluoroscopy(MD=6.53,95%CI 5.41~7.64,P<0.001).However,the 4CS group proved significantly superior to the 3CS group in terms of Harris score 6 months postoperatively(MD=5.07,95%CI 1.77~8.37,P=0.003),fracture healing time(MD=-0.35,95%CI-0.59~0.11,P=0.004),and fracture nonunion rate(OR=0.3,95%CI 0.11~0.84,P=0.02),femoral head necrosis rate(OR=0.52,95%CI 0.26~1.03,P=0.06)and screw loosening rate(OR=0.33,95%CI 0.13~0.83,P=0.02).There were no significant differences in incision length,postoperative walking time and hospital stay between the two groups(P>0.05).[Conclusion]The 4CS has the advantages of short fracture healing time,low incidence of fracture nonunion,high Harris score 6 months after sur-gery,low loosening rate,and significant better clinical outcomes over the 3CS in the treatment of femoral neck fracture.However,4CS re-quires longer operation time,more intraoperative bleeding and more intraoperative fluoroscopy than 3CS.

关 键 词：股骨颈骨折 空心钉 荟萃分析 

分 类 号：R683.42[医药卫生—骨科学]