解剖型钢板与动力髋螺钉治疗股骨转子间骨折的Meta分析

Anatomic plate versus dynamic hip screw in the treatment of intertrochanteric fractures: A Meta-analysis

背景:选择解剖型钢板或动力髋螺钉,哪种方法治疗股骨转子间骨折可使疗效更满意,目前尚未达成共识。且当前的研究仅限于小样本试验,很难做到大样本多中心治疗研究。目的:对公开发表的解剖型钢板与动力髋螺钉置入内固定治疗股骨转子间骨折的文献进行Meta分析,评价解剖型钢板与动力髋螺钉治疗股骨转子间骨折的疗效。方法:计算机检索美国医学文摘数据库(PubMed,1995至2013年)、FMJS外文全文数据库(EMCC,1995至2013年)、中国生物医学文献数据库(CBM,1995至2013年)、中国期刊全文数据库(CNKI,1995至2013年)、中文科技期刊全文数据库维普(VIP,1989至2013年)、万方数据库(1995至2013年),收集解剖型钢板与动力髋螺钉治疗股骨转子间骨折的临床对照试验。按照事先制定的入选与剔除标准筛选文献。然后逐一评价纳入研究的质量,提取有效数据,采用RevMan5.0软件进行Meta分析。结果与结论:共纳入19个临床对照试验,共1 730例患者,其中解剖型钢板组764例,动力髋螺钉组966例。Meta分析结果显示,2组比较骨折愈合时间、预后优良率、置入后并发症差异无显著性意义(P=0.34,0.58,0.80);解剖型钢板组手术时间、术中出血量、置入后引流量均优于动力髋螺钉组(P均<0.000 01)。提示解剖型钢板和动力髋螺钉置入内固定治疗股骨转子间骨折的疗效相似,但解剖型钢板治疗具有操作相对简单和出血量少等优点。由于研究纳入的研究质量较低,存在偏倚的高度可能,影响了结果的论证强度,期待更多高质量的随机双盲对照试验以提供高质量的证据。

BACKGROUND：There is no consensus on the choice of anatomic plate or dynamic hip screw for the treatment of intertrochanteric fracture. Current research is limited to smal-sample studies, and it is difficult to carry out a large-sample multicenter analysis. OBJECTIVE：To carry out Meta-analysis about the literature on anatomic plate versus dynamic hip screw in the treatment of intertrochanteric fractures, in order to evaluate the efficacy of anatomic plate versus dynamic hip screw in the treatment of intertrochanteric fractures. METHODS：The PubMed database （1995-2013）, EMCC database （1995-2013）, CBM database （1995-2013）, CNKI database （1995-2013）, VIP database （1989-2013） and Wanfang database （1995-2013） were searched by computer to col ect the control ed trials of anatomic plate versus dynamic hip screw for the treatment of intertrochanteric fractures. Then, the retrieved studies were screened according to predefined inclusion and exclusion criteria. The quality of the included studies was evaluated to extract useful y data, and Meta-analysis was performed by using the RevMan5.0 software. RESULTS AND CONCLUSION：A total of 19 control ed trials were included with a total of 1 730 cases. Among them, 764 cases were belonged to the anatomic plate group, and dynamic hip screw group included 966 cases. The Meta-analysis results indicated that there were no statistical y significant differences in fracture healing time, prognosis excellent and good rate and postoperative complications between two groups （P=0.34, 0.58, 0.80）;the operative time, intraoperative blood loss and postoperative drainage volume in the anatomic plate group were lower than those in the dynamic hip screw group （P〈0.000 01）. The results indicate that anatomic plate and dynamic hip screw have the similar clinical efficacy for the treatment of intertrochanteric fractures, but the anatomical plate has relatively simple operation and less bleeding. Due to the poor quality of the included literatures and high bias occur and influence the effect, so more wel-designed multi-center randomized control ed trials should be performed to provide high-quality evidence.