微创与传统动力髋螺钉治疗老年股骨转子间骨折疗效比较的Meta分析

Minimally invasive versus conventional dynamic hip screw for intertrochanteric fractures in the aged： a Meta-analysis

目的应用Meta分析的方法评价微创与传统动力髋螺钉（DHS）治疗老年股骨转子问骨折疗效的差异。方法计算机检索PubMed（1966年至2011年5月），EMBASE（1980年至2011年5月），Cochrane图书馆，中国期刊全文数据库（1994年至2011年5月）以及万方数据库（1993年至2011年5月），收集微创与传统DHS治疗老年股骨转子间骨折疗效比较的文献资料，比较两种方法的术后严重并发症的发生率、手术时间、手术前后血红蛋白差值、骨折愈合时间及术后髋关节Harris评分。利用RevMan5．0统计学软件进行异质性分析及Meta分析。结果共纳入10篇微创与传统DHS治疗老年股骨转子间骨折疗效比较的文献，共769例患者。研究结果提示微创DHS组患者术后严重并发症发生率较传统DHS组低（RR=0．30，95％C10．18～0．49，P〈0．001），手术时间较传统DHS组短（WMD：-21，47，95％CI—31．95--10．99，P〈0．001），手术前后血红蛋白差值较传统DHS组小（WMD=-1．44，95％CI-1．98～-0．89，P〈0．001），骨折愈合时间较传统DHS组短（WMD=-0．74，95％CI-1．16～一0．33，P〈0．001），术后髋关节Harris评分较传统DHS组高（WMD=1．60，95％CI0．68、2．53，P〈0．001）。结论与传统DHS比较，微创DHS治疗老年股骨转子间骨折具有手术时间短、术中出血量少、术后严重并发症少、骨折愈合陕及术后髋关节功能恢复好等优点。

Objective To compare minimally invasive dynamic hip screw （MIDHS） and conventional dynamic hip screw （CDHS） in the treatment of intertrochanteric fractures in the aged by a comprehen- sive meta-analysis. Methods The literature on treating intertrochanteric fractures with MIDHS and CDHS via PubMed （from 1966 to May 2011）, EMBASE （from 1980 to May 2011）, Cochrane library, CNKI （from 1994 to May 2011 ） and Wanfang database （from 1993 to May 2011 ） were collected. The rate of postoperative serious complication, operation time, haemoglobin decrease, healing time, and postoperative Harris hip score were the outcomes of interest. Meta-analysis and forest plots were conducted with RevMan5.0 software. Results Ten studies involving 769 fractures were included which compared the effects of the MIDHS and CDHS. The results showed a lower rate of postoperative serious complication with the MIDHS compared to the CDHS [relative risk（RR）： 0.30, 95% confidence interval （CI） O. 18 to 0.49, P 〈 0.001]. The average operating time [weighted mean difference （WMD）= -21.47, 95% CI -31.95 to -10.99, P 〈 0.001], haemoglobin decrease （WMD= -1.44, 95% CI -1.98 to -0.89, P 〈 0.001）, and the healing time （ WMD = - 0.74, 95% CI - 1. 16 to - 0.33, P 〈 0. 001） also appeared to be decreased with the use of MIDHS, and the postoperative Harris hip score （ WMD = 1.60, 95% CI 0. 68 to 2.53, P 〈 0. 001 ） was higher in the MIDHS fixation. Conclusion In the treatment of intertrochanteric fractures for the elderly patients, the MIDHS fixation is superior to the CDHS fixation due to its advantages of shorter operating time, less blood loss, fewer postoperative serious complications, faster fracture healing and better functional recovery.