股骨近端防旋髓内钉与常用髓内固定治疗成人股骨转子间骨折的Meta分析

背景：目前股骨转子间骨折的治疗主要采用髓外固定和髓内固定两种方式,从理论上来讲,髓内固定后稳定性更好、并发症更少。然而大量不同种类内固定装置的出现和存在,说明这些内固定物均有一定的缺陷和不足。目的：比较股骨近端防旋髓内钉与其他两种常用髓内固定（股骨近端髓内钉、Gamma钉）治疗成人股骨转子间骨折疗效的差异。方法：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,所有检索截止至2011-12-05。收集股骨近端防旋髓内钉与股骨近端髓内钉、股骨近端防旋髓内钉与Gamma钉固定治疗成人股骨转子间骨折的随机对照试验和非随机对照试验文献,严格评价纳入研究的方法学质量并提取资料。结果与结论：共纳入5个随机对照试验,13个非随机对照试验,共2185例患者,其中股骨近端防旋髓内钉组1013例,股骨近端髓内钉组658例,Gamma钉组514例。资料分析显示,与股骨近端髓内钉相比,股骨近端防旋髓内钉能缩短平均手术时间和减少平均术中出血量,但目前尚无足够证据表明股骨近端防旋髓内钉在术后并发症发生率和术后Harris评分优良率上优于股骨近端髓内钉;与Gamma钉相比,股骨近端防旋髓内钉能缩短平均手术时间和减少平均术中出血量,但目前尚无足够证据表明股骨近端防旋髓内钉在平均住院时间、平均骨折愈合时间、术后并发症发生率和术后Harris评分优良率上优于Gamma钉。

Meta analysis on intertrochanteric fractures in adults treated with proximal femoral nail anti-rotation and common intramedullary fixation

BACKGROUND：At present,the treatment of intertrochanteric fractures is mainly depending on extramedullary fixation and intramedullary fixation.Theoretically,the intramedullary fixation has the better stability and fewer complications.However,the emergence and existence of a large number of different types of fixtures demonstrate that these internal fixations have certain defects and deficiencies.OBJECTIVE：To compare the efficacy of proximal femoral nail anti-rotation versus other two common intramedullary fixations（proximal femoral nail and Gamma nail） in the treatment of intertrochanteric fractures in adults.METHODS：A computer-based search was performed on Cochrane library,Medline database,Elsevier database,Chinese Biomedical Database and Wanfang database for randomized controlled trials or non-randomized controlled trials on comparison between proximal femoral nail anti-rotation and proximal femoral nail,proximal femoral nail anti-rotation and Gamma nail fixation in the treatment of intertrochanteric fractures which were reported before 5 December 2011.Methodology quality of the trials was critically assessed and relative data were extracted.RESULTS AND CONCLUSION：A total of 5 randomized controlled trials and 13 non-randomized controlled trials involving 2 185 cases were included,1 013 cases in proximal femoral nail anti-rotation group,658 cases in proximal femoral nail group and 514 cases in Gamma nail fixation group.The results of meta-analysis showed that proximal femoral nail anti-rotation could significantly decrease the mean duration of surgery and mean intraoperative blood loss compared with proximal femoral nail.However,no insufficient evidence demonstrated that proximal femoral nail anti-rotation was better than proximal femoral nail in the rate of postoperative complication and the excellent and good rate of Harris score.It also showed that proximal femoral nail anti-rotation could significantly decrease the mean duration of surgery and mean intraoperative blood loss when compared with Gamma nail.However,there were no statistic differences in the mean duration of hospital,mean duration of fracture healing,the rate of postoperative complication and the excellent and good rate of Harris score between proximal femoral nail anti-rotation and Gamma nail treatment.