股骨近端髓内钉与动力髋螺钉固定治疗老年股骨转子间骨折的系统评价

Systematic review on proximal femoral nail versus dynamic hip screw fixation for treatment of intertrochanteric fracture in the aged

目的:评价股骨近端髓内钉(proximal femoral nail,PFN)和动力髋螺钉(dynamic hip screw,DHS)固定治疗老年股骨转子间骨折的临床疗效和安全性。方法:英文数据库以trochanteric fracture AND dynamic hip screw(DHS)AND proximal femoral nail(PFN)AND randomized controlled trials(RCT)OR quasi-RCT为检索词;中文数据库以股骨粗隆间骨折AND动力髋螺钉AND股骨近端髓内钉AND随机对照,股骨转子间骨折AND动力髋螺钉AND股骨近端髓内钉AND随机对照为检索词。以计算机检索Medline、Embase、Cochrane图书馆、Cochrane协作网专业实验数据库、中国生物医学文献数据库、中国知网、万方学术期刊数据库及中文科技期刊全文数据库建库至2014年4月的所有相关文献。采用Cochrane国际协作组织提供的Review Manager4.2.10软件进行统计分析。结果:共检索出文献181篇,经过筛选最终纳入9篇文献,其中英文文献3篇、中文文献6篇,共涉及1236例患者。PFN组较DHS组手术时间短、术中出血量少、手术优良率高[OR=-2.730,95%CI(-2.95,-2.51);OR=-1.900,95%CI(-2.09,-1.71);OR=2.480,95%CI(1.38,4.48)]。2组的螺钉切出率及再次手术率比较,组间差异均无统计学意义[OR=1.290,95%CI(0.39,4.29);OR=1.740,95%CI(0.61,4.95)]。结论:与DHS固定相比,PFN固定治疗老年股骨转子间骨折手术时间短、出血量少、手术优良率高,二者的安全性相当。

Objective：To compare the clinical curative effect and safety between proximal femoral nail（PFN）fixation and dynamic hip screw（DHS）fixation in the treatment of intertrochanteric fracture in the aged.Methods：The logical combination of trochanteric fracture,dy-namic hip screw（DHS）,proximal femoral nail（PFN）and randomized controlled trials（RCT）or quasi-RCT were chosen as index terms. All the relevant literatures included from database establishing to April 201 4 were retrieved from Medline,Embase,Cochrane library,Co-chrane collaboration,Chinese Biomedical Disc（CBMdisc）,China national knowledge internet,Wanfang Database and China Science and Technology Journal Full-text Database through computer.Statistical analysis was conducted by using ReviewManager4.2.1 0 software pro-vided by Cochrane collaboration networks.Results：One hundred and eighty-one literatures were searched out.After screening,9 literatures （1 236 patients）were included in the final analysis,including three English literatures and six Chinese literatures.The result of Meta-analy-sis demonstrated that PFN has shorter operative time,less blood loss and better curative effect compared to DHS（OR=-2.730,95%CI （-2.95,-2.51 ）;OR=-1 .900,95%CI（-2.09,-1 .71 ）;OR=2.480,95%CI（1 .38,4.48））.There was no statistical difference in the incidence rate of screw protrusion and reoperation between the two groups（OR=1 .290,95%CI（0.39,4.29）;OR=1 .740,95%CI （0.61 ,4.95））.Conclusion：PFN fixation has shorter operative time,less blood loss and better curative effect compared to DHS fixation for treatment of intertrochanteric fractures in the aged patients,while they are similar to each other in safety.