动力髋螺钉、股骨近端抗旋髓内钉与联合加压交锁髓内钉系统修复股骨转子间骨折(英文)

Dynamic hip screw, proximal femoral nail antirotation and Inter Tan nail for intertrochanteric fractures

背景:髓外固定系统包括动力髋螺钉常用于治疗股骨转子间骨折;但在不稳定性股骨转子间骨折的患者中,髓外固定系统往往会导致骨折固定失败。髓内固定系统包括股骨近端抗旋髓内钉和联合加压交锁髓内钉系统广泛用于治疗不稳定性股骨转子间骨折。目的:比较髓外固定系统包括动力髋螺钉,股骨近端抗旋髓内钉和联合加压交锁髓内钉系统治疗股骨转子间骨折的疗效。方法:检索万方数据库、Pub Med、Embase、Medline和Cochrone library从1990年1月到2014年11月的文献。对髓外固定系统包括动力髋螺钉,股骨近端抗旋髓内钉和联合加压交锁髓内钉系统的相关文献进行筛选。结果与结论:通过对346篇文献进行筛选,共有13篇文献符合标准,其中共纳入1 271例不同类型的股骨转子间骨折患者。与髓外固定系统包括动力髋螺钉组相比,股骨近端抗旋髓内钉组和联合加压交锁髓内钉系统组患者手术时间更短,且出血量更少,但3种固定方法患者康复时间和愈后Harris评分差异无显著性意义。此外,股骨近端抗旋髓内钉和联合加压交锁髓内钉系统的疗效相似。提示与髓外固定系统包括动力髋螺钉相比,股骨近端抗旋髓内钉和联合加压交锁髓内钉系统虽可优化手术过程,但不能提升术后恢复效果。

BACKGROUND： The extramedullary fixation system including dynamic hip screw（DHS） is commonly used in treatment of Intertrochanteric fracture. However, in patients with unstable intertrochanteric fracture, extramedullary fixation system often leads to the failure of fracture fixation. Intramedullary fixation system including both proximal femoral nail antirotation（PFNA） and Inter Tan nail has been widely used in the treatment of unstable intertrochanteric fractures. OBJECTIVE： To compare the therapeutic effects of extramedullary fixation system containing DHS, PFNA and Inter Tan nail in the treatment of intertrochanteric fracture. METHODS： Literatures were searched in Wanfang, Pub Med, Embase, Medline, the Cochrane library to screen literatures published from January 1990 to November 2014. Relevant studies addressing extramedullary fixation system containing DHS, PFNA and Inter Tan nail were screened. RESULTS AND CONCLUSION： 346 articles were screened, and 13 of them were in accordance with the inclusion criteria. 1 271 patients with different types of intertrochanteric fracture were assessed in this study. Compared to DHS group, patients treated with PFNA and Inter Tan nail had shorter operation time and less blood loss. No significant difference in rehabilitation time and Harris score was detected among three kinds of fixation methods. Additionally, PFNA and Inter Tan nail had a similar effect. These findings verify that compared with DHS, PFNA and Inter Tan nail can optimize the surgery, but cannot elevate postoperative outcomes.