股骨近端防旋髓内钉与动力髋螺钉固定治疗股骨转子间骨折的Meta分析

目的:探讨股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)与动力髋螺钉(dynamic hipscrew,DHS)固定治疗股骨转子间骨折的疗效差异。方法:运用计算机检索Cochrane图书馆、MEDLINE数据库、Elsevier数据库、中国生物医学文献数据库、万方数据库以及手工检索相关文献的参考文献。所有检索截至2011年12月5日。收集PFNA与DHS固定比较治疗股骨转子间骨折随机对照试验的英文及中文文献,严格评价纳入研究的方法学质量并提取资料。统计软件采用RevMan5.0。结果:共纳入13项随机对照试验,共958例患者,其中PFNA组475例,DHS组483例。资料分析显示,PFNA固定与DHS固定比较,手术时间缩短[WMD=-21.38,95%CI(-33.050,-9.26),P<0.05]、术中失血量减少[WMD=-176.36,95%CI(-232.20,-120.52),P<0.05]、术后总并发症发生率降低[RR=0.46,95%CI(0.31,0.70),P<0.05]、术后内固定失效发生率降低[RR=0.27,95%CI(0.11,0.62),P<0.05]。结论:与DHS相比,PFNA能缩短平均手术时间,减少平均术中出血量,降低术后总并发症发生率以及术后内固定失效发生率;但目前尚无足够证据表明PFNA在减少平均住院时间、平均术后骨折愈合时间以及降低术后骨折发生率、髋内翻发生率、术后浅表切口感染发生率、术后其他并发症发生率和术后Harris评分优良率上要优于DHS。

Meta-analysis of proximal femoral nail anti-rotation versus dynamic hip screw in the treatment of trochanteric fractures

Objective: To compare the efficacy of proximal femoral nail anti-rotation(PFNA) versus dynamic hip screw(DHS) in the treatment of trochanteric fractures in adults. Methods: Reports of studies using randomized controlled trials(RCT) to compare PFNA with DHS in the management of intertrochanteric fractures were retrieved(up to December 5,2011) from the Cochrane Library,MEDLINE,Elsevier,the Chinese Biomedical Database,Wanfang Data,and manually.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman? 5.0 was used for data-analysis. Results: Thirteen RCTs involving 958 cases were included in the Meta-analysis.The results showed that,compared with DHS,PFNA significantly decreased the duration of surgery [WMD = –21.38,95%CI(–33.05,–9.26),P<0.05],intra-operative blood loss [WMD = –176.36,95%CI(–232.20,–120.52),P<0.05],the rate of post-operative complication [RR=0.46,95%CI(0.31,0.70),P<0.05],the rate of post-operative fixation failure[RR=0.27,95%CI(0.11,0.62),P<0.05]. Conclusion: PFNA for intertrochanteric fractures is superior to DHS in regards to the mean duration of surgery,mean intra-operative blood loss,the rate of post-operative complication,and the rate of post-operative fixation failure.But there is not enough evidence to show any difference between PFNA and DHS in regards to the mean duration of hospital,the mean duration of fracture healing,the rate of post-operative fracture,the rate of post-operative coxa vara,the rate of post-operative superficial wound infection,the rate of other post-operative complications or the Harris score after surgery.