PFNA与DHS内固定治疗骨质疏松性股骨粗隆间骨折的Meta分析

Meta-analysis of PFNA versus DHS in treatment of osteoporotic femoral intertrochanteric fractures

目的通过Meta分析评价股骨近端防旋髓内钉(PFNA)与动力髋螺钉(DHS)内固定治疗骨质疏松性股骨粗隆间骨折的治疗效果。方法通过检索CNKI、Medline、CBM数据库及Cochrane图书馆中比较PFNA与DHS内固定治疗骨质疏松性股骨粗隆间骨折临床效果的随机对照实验和回顾性队列研究文献,并追查已纳入文献的参考文献,由至少2位系统评价员做独立的文献筛查、资料提取和质量评价,并交叉核对,不同意见请第3位评价员裁决。所得数据通过RevMan5.0统计软件完成Meta分析,比较PFNA组与DHS组的手术时间、术中出血量、术后并发症、术后死亡率。结果共纳入了16篇文献中的1 049例股骨粗隆间骨折。Meta分析结果显示:与DHS组相比,PFNA组的手术操作时间更短、失血量更少、并发症更少;但是在术后死亡率方面,2组间差异无统计学意义(P>0.05)。结论在治疗骨质疏松性股骨粗隆间骨折时,PFNA内固定可以明显短缩手术时间、减少术中及术后出血量以及可能发生的并发症。但目前尚无足够证据证明PFNA内固定在术后死亡率方面优于DHS,对于PFNA的长期疗效有待更进一步的研究。

Objective To compare the efficacy of proximal femoral nail anti-rotation （PFNA） versus dynamic hip screw（DHS） in the treatment of osteoporotic femoral intertrochanteric fractures. Methods A meta-analysis of all the relevant randomized controlled trials（RCT） was performed. From CNKI, Medline, CBM, Cochrane library, articles in the academic degree collections were searched. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis. Results A total of 16 trials involving 1 049 Patients were identified as meeting all the eligibility criteria. The results showed that, compared with DHS, PFNA significantly decreased the duration of surgery, intra-operative Blood loss, the rate of post-operative complication （P 〈0.001）, but the two groups had no statistical difference in mortality rates （P 〉0.05）. Conclusion PFNA for osteoporotic intertrochanteric fracture is superior to DHS in regards to the mean duration of surgery, intra-operative blood loss, the rate of post-operative complication, but there is not enough evidence to show any statistical difference between PFNA and DHS in regards to the mean mortality rates after surgery.