摘要
[目的]对比分析国内最近五年内成年股骨转子下骨折不同手术的疗效.[方法]使用国内中文数据库,检索与筛选国内五年内股骨转子下骨折治疗的文献资料,汇总分析各种手术方式的效果及并发症.[结果]本研究共检索到文献712篇,经过剔重、阅读摘要及查看全文筛选后,最终纳入文献186篇,涉及股骨转子下骨折患者6960例,其中男4 005人,女2 955人.髓内固定手术手术时间、术中出血量、切口长度及Harris评分显著优于髓外固定手术(P<0.05).髓内固定中PFNA、interTAN及γ3钉组围手术期资料优于PFN组(P<0.05);髓外固定中DHS、PFLP、LISS组围手术期资料优于DCS组(P<0.05).在Harris评分优良率方面,四组髓外固定组的Harris评分优良率均低于90.00%,PFLP、LISS组优良率明显高于DHS (76.63%).在术后并发症方面,PFNA组、INTERTAN组、γ3组明显低于PFN组、DCS组、DHS组、股骨近端锁定钢板组(PFLP)、LISS组(P<0.05).[结论]在手术时间、术中出血量、切口长度、骨折愈合时间、Harris评分优良率及术后并发症发生率方面,以PFNA为主的髓内固定的手术效果明显优于髓外固定.
[Object] To compare the clinical outcomes among different surgical procedures for adult femoral subtrochanteric fractures in the past five years in China.[Methods] The literatures on the surgical treatment of subtrochanteric fractures in this country within five years were sought out by using Chinese database. A pooled analysis was conducted to compare the clinical outcomes and complications among different surgical procedures for adult femoral subtrochanteric fractures.[Results] A total of 712 papers were retrieved, of which 186 articles met the including standard were enrolled into this study after the assess - ment by reading the abstract and full articles, involving 6 960 patients who underwent surgical treatment for femoral subtrochanteric fractures, including 4 005 males and 2 955 females. The intramedullary fixations proved significantly superior to the extramedullary fixations regarding to operation time, intraoperative blood loss, incision length and Harris score (P<0.05). The PFNA, InterTAN and Gamma 3 nail were significantly superior to the PFN among the 4 intramedullary fixations, whereas the DHS PFLP and LISS were far superior to the DCS among the 4 extramedullary fixations regarding to aforesaid perioperative parameters (P<0.05). In term of the excellent and good rate based on Harris score, the 4 extramedullary fixation were documented less than 90%, nevertheless the rates in PFLP and LISS were significantly higher than the DHS (76.63%)(P<0.05). In addition, the PFN, interTan and Gamma 3 nail proved significantly less chance of complications than the PFN, DCS, DHS , PFLP and LISS (P<0.05).[Conclusions] Regarding to operation time, intraoperative blood loss, length of incision, Harris score and postoperative complications, the intramedullary fixations such as PFNA are significantly superior to the extramedullary fixations for femoral subtrochanteric fractures.
作者
何培亮
李爱国
彭涛
曹良国
HE Pei-liang;LI Ai-guo;PENG Tao;CAO Liang-guo(Guizhou Medical University,Gui-yang 550000,China;Red Cross Hospital of Guangzhou City, Jinan University, Guangzhou 510000, China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第12期1106-1110,共5页
Orthopedic Journal of China
关键词
股骨转子下骨折
髓内固定
髓外固定
femoral subtrochanteric fracture
intramedullary fixation
extramedullary fixation
