股骨近端髓内钉与滑动髋螺钉固定治疗成人股骨转子间骨折的系统评价

Proximal femoral nails versus sliding hip screws in treatment of intertrochanteric fractures in adults： a systematic review

目的系统评价股骨近端髓内钉（PFN）与滑动髋螺钉（SHS）固定治疗成人股骨转子间骨折的疗效差异。方法计算机检索Cochrane图书馆、MEDLINE数据库、EMBASE数据库、中国生物医学文献数据库，手工检索相关文献的参考文献及4种中文主要骨科杂志。收集PFN与SHS固定比较治疗成人股骨转子间骨折的随机对照试验，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RevMan4．2．10。结果共纳入3个随机对照试验，1个半随机对照试验。资料分析显示，PFN固定与SHS固定比较，在平均手术时间、平均术中失血量、病死率、术后股骨干骨折发生率、拉力螺钉切出率、骨折不愈合率、再次手术率和伤口感染率方面，两者间无显著差异。结论目前尚没有足够的证据表明PFN固定治疗成人股骨转子间骨折优于SHS，还需要开展更多高质量、大样本的临床随机对照试验以增加证据的强度。

Objective To compare the efficacy of proximal femoral nails （PFN） versus sliding hip screws （SHS） in the treatment of intertrochanteric fractures in adults. Methods According to Cochrane systematic review, Cochrane library, Medline, Embase and Chinese Biomedical Database were searched for randomized controlled trials （RCT） comparing PFN with SHS in the management of intertrochanteric fractures from 1996 to the end of June 2007. Furthermore, we also searched manually relevant references and Chinese orthopedic journals. Methodology quality of the trials was critically assessed and relative data were extracted. Statistical software Revman 4. 2. 10 was used for data-analysis. Results Three RCTs and 1 quasi-RCT involving 458 cases were included. The results of meta-analysis showed that no statistically significant differences were found in the mean duration of surgery, mean intraoperative blood loss, mortality, postoperative femoral shaft fractures, lag screw cut-out, nonunion, reoperation and wound infection between PFN and SHS. Conclusions There is not enough evidence showing any obvious advantage of PFN fixation over SHS fixation in the treatment of intertrochanteric fractures in adults. Because the number of trials available for a systematic review is too small for a reliable estimate, large-scale and high-quality RCTs are needed to further determine the effects of PFN fixation versus SHS fixation.