Gamma钉与动力髋螺钉治疗股骨转子间骨折的Meta分析

背景：股骨转子间骨折早期的内固定是一种积极有效的治疗手段，临床上老年人股骨转子间骨折的治疗方法较多，疗效不一，各有优缺点。 目的：探讨Gamma钉与动力髋螺钉治疗股骨转子间骨折临床疗效方面的差异。 方法：检索CENTRAL(the Cochrane central register of controlledtrials)、Medline 、EMBASE、万方、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)等，收集国内外公开发表的Gamma钉与动力髋螺钉治疗股骨转子间骨折的临床随机对照研究。根据Cochran手册提出的文献质量评价标准对纳入研究进行质量评价。应用统计软件Stata11.0进行数据分析。 结果与结论：最终纳入分析的文章有12篇，Gamma钉组888例，动力髋螺钉组981例。Meta分析的结果显示接受Gamma钉治疗的患者与接受动力髋螺钉患者比较：置入后股骨干骨折风险增高、置入时间较短、置入中出血量较少，差异有显著性意义(P < 0.05)。两组患者置入后感染风险、内固定优良率、住院时间方面差异无显著性意义(P > 0.05)。说明与动力髋螺钉相比，接受Gamma钉治疗的患者内固定置入时间短，出血少但置入后股骨干骨折的风险增加。

Gamma nail compare with dynamic hip screw in treating intertrochanteric fracture:A meta-anlyisis of 8 randomised controlled trials

BACKGROUND: Early fixation for intertrochanteric fractures is positive and effective, and the clinical therapies for intertrochanteric fractures in the elderly are different and each has its advantages and disadvantages. OBJECTIVE: To explore the clinical effect of Gamma nail versus dynamic hip screw in the treatment of intertrochanteric fractures. METHODS: By searching CENTRAL (the Cochrane central register of controlled trials), Medline EMBSE, WANFANG, CBM and CNKI, we collected randomized controlled trials about the Gamma nail versus dynamic hip screw for intertrochanteric fractures. The methodological quality was assessed by using Cochrane Handbook. The data was analyzed by using statistic software Stata 11.0. RESULTS AND CONCLUSION: Twelve trials were analyzed in the final analysis. Totally 888 patients were in the gamma nail group and 981 patients were in the dynamic hip screw group. A higher rate of postoperative femoral shaft fracture, shorter operation time and less blood loss were observed in the Gamma nail group compared with DHS group (P < 0.05); But no statistical difference was found in wound infection, operation good rate and hospital stay between the two groups. Gamma nail can shorten the operation time and reduce the amount of blood loss, but increase the risk of postoperative femoral shaft fracture.