PFNA与DHS治疗成人股骨粗隆间骨折的Meta分析

Comparison between PFNA and DHS in Treatment of Intertrochanteric Fracture in Adults:a Metaanalysis

目的通过Meta分析比较防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)与动力髋螺钉(dynamic hip screw,DHS)治疗成人股骨粗隆间骨折的疗效差异。方法计算机检索Cochrane图书馆、MEDLINE数据库、EMBASE数据库、CNKI、万方数据库、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PFNA与DHS比较治疗治疗成人股骨粗隆间骨折的随机对照研究或半随机对照研究,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Cochrane协作网提供的RevMan 5.0。结果 PFNA与DHS治疗成人股骨粗隆间骨折的系统评价共纳入了6个随机对照试验,1个半随机对照试验。其中1个研究方法质量学为A级,4个B级,1个C级。研究分析结果显示:与DHS固定比较,PFNA固定能减少术中出血,并能缩短住院时间,但是PFNA与DHS两种固定方式在静脉血栓发生率、术后股骨骨折发生率、术后切口感染、髋关节Harris评分、髋内翻及内固定的移位、切出或断裂等方面均无显著差异。尚不能判定PFNA与DHS两种固定方法在平均手术时间方面是否具有差异。结论与DHS固定比较,PFNA固定能减少术中出血,并能缩短住院时间,但尚不能判定PFNA与DHS两种固定方法在平均手术时间方面是否具有差异。

Objective To assess the eitects oi PFNA and DH5 in the treatment ol mtertrochantemc lractures. Methods According to Cochrane systematic review, Cochrane library, Medline, Embase, CNKI, Wanfang Data and Chinese Biomedical Database were searched for randomized controlled trials comparing PFNA with DHS in the man- agement of intertmchanteric fractures. Furthermore,we also searched manually relevant references and Chinese ortho- pedic journals. Methodology quality of the trials was critically assessed and relative data were extracted. Statistical software Revman 5.0 was used for data-analysis. Results 5 randomized controlled trails and 1 Quasi-randomized con- trolled trail involving 429 cases were included. The results of Meta-analysis showed that no statistically significant dif- ferences were found in the post-operative femoral fractures ,wound infection,thromboembolism,post-operative Harris scores,coxa vara and fixation migration or screw cut-out between PFNA and DHS,but compared with DHS,PFNA has less blood loss and hospital stay. Conclusion Compared with the fixation of PFNA for intertrochanteric fractures in adults ,DHS fixation can lead to more blood loss and longer hospital stay. However ,there is still no enough evidence to give the conclusion that there is significant difference of the mean length of surgery time between PNFA and DHS in treating adult femur intertrochanteric fractures.