王奔 1葛振新 1杨国跃 2张东正 1张银光 3田维 3刘兆杰 3贾健3
作者信息
- 1. 天津医科大学研究生院，天津市 300200
- 2. 天津市第三中心医院骨科，天津市300170
- 3. 天津市天津医院创伤骨科，天津市 300211
- 折叠
摘要
Abstract
BACKGROUND: The choice of intramedul ary nails versus extramedul ary fixation in surgical treatment of intertrochanteric fractures remains controversial. OBJECTIVE: To evaluate the efficacy of intramedul ary versus extramedul ary fixation for the treatment of intertrochanteric fractures. METHODS: A computer-based search was performed on the MEDLINE database, EMBASE database, Cochrane Library, CBM database, CNKI database and other commonly used electronic database, supplemented by manual searches to find the randomized control ed trials on the comparison of intramedul ary versus extramedul ary fixation for the treatment of intertrochanteric fractures at home and abroad. Al randomized control ed trials comparing the efficacy of intramedul ary versus extramedul ary internal fixation for the treatment of intertrochanteric fractures were included. The included studies were evaluated with the modified Jadad quality scale, and the software Stata 12.0 and RevMan 5.1 were used for data analysis. The statistical method was the Mantel-Haenszel method. RESULTS AND CONCLUSION: A total of 31 randomized control ed trials were included, including 5 217 patients. According to the modified Jadad quality scale, 19 literatures of methodological quality showed high quality, and low quality of 12 literatures. The intraoperative femoral fractures [relative risk (RR)=4.00, 95% confidence interval (CI) (1.80-8.86), P < 0.01], postoperative femoral fracture [RR=3.57, 95%CI (1.68-7.60), P < 0.01], cut out [RR=1.61, 95%CI (1.02-2.52); P=0.04], reoperation risk [RR=1.58, 95%CI (1.09-2.30); P=0.02], and residual hip or thigh pain in the fol ow-up period [RR=1.31, 95%CI (1.09-1.57), P < 0.01] in the Gamma nail group was significantly higher than those in the sliding hip screw group. The intraoperative blood loss in the proximal femoral nail anti-rotation group was significantly less than that in the sliding hip screw group, and the hip joint Harris score was higher, but the intraoperative radiation time was longer [mean difference (MD)=2.11, 95%CI (1.78-2.43), P < 0.01]. The intraoperative blood loss in the intramedul ary hip screw group was significantly less than that in the sliding hip screw group, but the radiation time was longer [MD=1.20, 95%CI (0.88-1.52), P < 0.01]. For stable intertrochanteric fracture, both screw-plate system and intramedul ary fixation have good outcome, but the dynamic hip screw as the representative of extramedul ary fixation system is preferred. The intramedul ary system is better than extramedul ary fixation system in the treatment of unstable intertrochanteric fractures.关键词
骨关节植入物/骨与关节植入物循证医学/股骨转子间骨折/Gamma 钉/动力髋螺钉/股骨近端髓内钉/股骨近端抗旋髓内钉/骨折内固定/Meta 分析/组织工程分类
医药卫生
