摘要
背景:股骨近端锁定加压钢板与动力髋螺钉作为临床修复股骨转子间骨折两种主要的髓外固定方法,其疗效孰优孰劣,目前仍有争议。目的:系统评价解剖型锁定加压钢板与动力髋螺钉治疗股骨转子间骨折的临床疗效,为临床应用提供理论依据。方法:运用计算机检索1999年1月至2014年4月的PubMed、Embase、Cochrane图书馆、中国知网、维普期刊数据库、万方资源数据库、中国生物医学文献服务系统,搜集解剖型锁定加压钢板与动力髋螺钉修复股骨转子间骨折临床疗效比较的对照研究。制定入选和剔除标准,筛选出符合纳入标准的文献,评价纳入研究的方法学质量。利用RevMan5.2进行Meta分析。结果与结论:最终有8篇研究符合纳入标准,共682例患者,其中锁定加压钢板组336例,动力髋螺钉组346例。Meta分析结果显示:锁定加压钢板组的手术时间[MD=-12.07,95%CI(-29.85,5.71),P=0.18]、术中出血量[MD=-15.01,95%CI(-87.85,57.83),P=0.69]、术后引流量[MD=-13.62,95%CI(-28.49,1.26),P=0.07]、下地活动时间[MD=-0.14,95%CI(-0.68,0.41),P=0.63]、住院时间[MD=-0.74,95%CI(–2.29,0.82),P=0.35]、骨折愈合时间[MD=-1.18,95%CI(-2.78,0.42),P=0.15]均与动力髋螺钉组无明显差别。而对于术后髋关节功能恢复的优良率[OR=2.03,95%CI(1.23,3.36),P=0.006],锁定加压钢板组则明显高于动力髋螺钉组。并发症方面,锁定加压钢板组的髋内翻发生率[OR=0.34,95%CI(0.12,0.96),P=0.04]低于动力髋螺钉组,但对于内固定松动、断裂、退出[OR=1.20,95%CI(0.59,2.45),P=0.61]和总的并发症发生率[OR=0.55,95%CI(0.24,1.28),P=0.16],两者则无明显差别。鉴于纳入研究存在选择性偏倚和测量性偏倚的高度可能性,势必影响结果的论证强度,因此尚需更多设计严谨的临床随机对照研究加以证实。
BACKGROUND：Locking compression plate and dynamic hip screw are the two major extramedul ary fixations for the femoral intertrochanteric fractures, however, the comparison of the clinical efficacy between two methods is stil controversial. OBJECTIVE：To systematical y evaluate the clinical efficacy of locking compression plate versus dynamic hip screw in the treatment of femoral intertrochanteric fractures, and provide a theoretical basis for clinical application. METHODS：Authors searched for control ed studies on locking compression plate and dynamic hip screw in the treatment of femoral intertrochanteric fractures in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP periodical database, Wanfang resource database, Chinese Biomedical Literature service systems published from January 1999 to April 2014. The inclusion and exclusion criteria were made, and the literature meeting the criteria was screened, and the methodological quality of the included studies was evaluated. Meta-analysis was carried out using the RevMan 5.2 software. RESULTS AND CONCLUSION：Ultimately 682 patients from 8 studies met the inclusion criteria, including 336 patients in the locking compression plate group and 346 patients in the dynamic hip screw group. Meta-analysis results showed that：there were no statistical y significant differences in operating time [MD=-12.07, 95%CI （-29.85, 5.71）, P=0.18], peri-operative bleeding loss [MD=-15.01, 95%CI （-87.85, 57.83）, P=0.69], post-operation drainage [MD=-13.62, 95%CI （-28.49, 1.26）, P=0.07], ambulation time [MD=-0.14, 95%CI （-0.68, 0.41）, P=0.63], length of hospitalization [MD=-0.74, 95%CI （-2.29, 0.82）, P=0.35], bone union time [MD=-1.18, 95%CI （-2.78, 0.42）, P=0.15] between locking compression plate and dynamic hip screw groups. The excellent and good rate of postoperative hip function reduction [OR=2.03, 95%CI （1.23, 3.36）, P=0.006] was significantly higher in locking compression plate group than in the dynamic hip screw group. The incidence of coxa vara was lower in the locking compression plate group than in the dynamic hip screw group [OR=0.34, 95%CI （0.12, 0.96）, P=0.04]. There were no significant differences in looseness, breakage, withdrawal of internal fixation [OR=1.20, 95%CI （0.59, 2.45）, P=0.61] and the incidence of total complications [OR=0.55, 95%CI （0.24, 1.28）, P=0.16] between locking compression plate and dynamic hip screw groups. However, the included studies have high possibility of selection bias and measurement bias, and wil affect proof strength of results. Therefore, more clinical randomized control ed studies with compact design are needed for verification.
出处
《中国组织工程研究》
CAS
CSCD
2014年第35期5715-5722,共8页
Chinese Journal of Tissue Engineering Research
