股骨颈骨折空心螺钉内固定术后股骨颈短缩危险因素的Meta分析  

Risk factors for femoral neck shortening after hollow screw internal fixation for femoral neck fracture:a meta analysis

作　　者：邝孝坤 田可为 范克杰 马文龙 刘英科 严嘉祥 王敬威 田燃 栗林 陈柯 KUANG Xiaokun;TIAN Kewei;FAN Keje;MA Wenlong;LIU Yingke;YAN Jiaxiang;WANG Jingwei;TIAN Ran;LI Lin;CHEN Ke(Postgraduate College of Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China;Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China)

机构地区：[1]河南中医药大学研究生院,河南郑州450046 [2]河南省洛阳正骨医院/河南省骨科医院,河南洛阳471002

出　　处：《中医正骨》2024年第10期44-51,共8页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：河南省重点研发与推广专项项目(182102310467);河南省医学科技攻关计划项目(LHGJ20230483);河南省中医药科学研究专项课题(20-21ZY2253,20-21ZY2238)。

摘　　要：目的:系统评价股骨颈骨折(femoral neck fracture,FNF)空心螺钉内固定术后股骨颈短缩(femoral neck shortening,FNS)的危险因素。方法:检索中国知网、中国生物医学文献服务系统、万方数据库、维普网、PubMed、Cochrane Library、Embase、Web of Science,搜集有关FNF空心螺钉内固定术后FNS危险因素的队列研究或病例对照研究,检索时限均为建库至2024年3月1日。由2名研究人员独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Stata16.0软件进行Meta分析。结果:共纳入16项研究,均为病例对照研究,共涉及1583例FNF患者。Meta分析结果显示,年龄[MD=3.10,95%CI(0.36,5.84),P=0.026]、骨质疏松[OR=3.44,95%CI(2.50,4.75),P=0.000]、Singh指数Ⅳ~Ⅵ级[OR=1.57,95%CI(1.11,2.23),P=0.011]、GardenⅢ~Ⅳ型[OR=3.65,95%CI(1.95,6.85),P=0.000]、PauwelsⅢ型[OR=5.01,95%CI(2.98,8.43),P=0.000]、切开复位[OR=3.29,95%CI(1.69,6.42),P=0.000]、Garden指数Ⅲ~Ⅳ级[OR=5.15,95%CI(3.94,6.74),P=0.000]均为FNF空心螺钉内固定术后FNS的危险因素;性别、高血压病史、糖尿病病史、置钉方式、住院时间与FNS的关联性均无统计学意义。体质量指数按照数据类型进行亚组分析,二分类变量组(≤24 kg·m^(-2)/>24 kg·m^(-2))的分析结果显示,体质量指数>24 kg·m^(-2)是FNS的危险因素[OR=3.32,95%CI(2.19,5.03),P=0.000];连续性变量组的分析结果显示,体质量指数与FNS的关联性无统计学意义。受伤至手术时间按照时间划分的界值进行亚组分析,24 h界值组(≤24 h/>24 h)的分析结果显示,受伤至手术时间与FNS的关联性无统计学意义;4 d界值组(≤4 d/>4 d)的分析结果显示,受伤至手术时间>4 d是FNS的危险因素[OR=2.04,95%CI(1.46,2.86),P=0.000]。完全负重时间按照时间划分的界值进行亚组分析,2个月界值组(≤2个月/>2个月)的分析结果显示,术后2个月内完全负重是FNS的危险因素[OR=2.57,95%CI(1.03,6.38),P=0.000];3个月界值组(≤3个月/>3�Objective:To systematically review the risk factors for femoral neck shortening(FNS)after internal fixation with hollow screw for treating femoral neck fracture(FNF).Methods:All the cohort study articles and case-control study articles about the risk factors for FNS after internal fixation with hollow screw for FNF included from database's inception to March 1,2024 were retrieved from the China National Knowledge Infrastructure,Chinese Biomedical Literature Service System,Wanfang Database,Vip Database,PubMed,Cochrane Library,Embase and Web of Science.The pertinent articles were screened,the information was extracted and the risk of bias of the included researches was assessed independently by two researchers,and then a Meta-analysis was conducted by using Stata16.0 software.Results:Sixteen case-control study articles were included in the final analysis,involving 1583 FNF patients.The results of Meta-analysis revealed that the age(MD=3.10,95%CI(0.36,5.84),P=0.026),osteoporosis(OR=3.44,95%CI(2.50,4.75),P=0.000),Singh's index graded fromⅣtoⅥ(OR=1.57,95%CI(1.11,2.23),P=0.011),Garden typeⅢ-Ⅳ(OR=3.65,95%CI(1.95,6.85),P=0.000),Pauwels typeⅢ(OR=5.01,95%CI(2.98,8.43),P=0.000),open reduction(OR=3.29,95%CI(1.69,6.42),P=0.000),Garden's index graded fromⅢtoⅣ(OR=5.15,95%CI(3.94,6.74),P=0.000)were the risk factors for FNS in patients who underwent hollow screw internal fixation for FNF;while,the associations of gender,hypertension history,diabetes mellitus history,screw placement method,and hospital stays with FNS were not statistical significant.A subgroup analysis on body mass index(BMI)was conducted according to the data type,and the results of binary variable group(BMI≤24 kg/m^(2)or>24 kg/m^(2))showed that a BMI greater than 24 kg/m^(2)was the risk factor for FNS(OR=3.32,95%CI(2.19,5.03),P=0.000);while the results of continuous variable group indicated that the association between BMI and FNS was not statistical significant.Additionally,a subgroup analysis on time from injury to surgery was performed accordi

关 键 词：股骨颈骨折 骨折固定术 内 骨螺丝 股骨颈短缩 危险因素 专题Meta分析 

分 类 号：R687.3[医药卫生—骨科学]