PFNA与LCP内固定治疗成年股骨粗隆间骨折疗效的Meta分析

Meta-analysis of efficacy of proximal femoral nail antirotation and locking compression plate in treatment of femoral intertrochanteric fracture in adult

目的对股骨近端防旋髓内钉(PFNA)与股骨近端锁定钢板(LCP)内固定治疗成年股骨粗隆间骨折的文献进行Meta分析,以比较二者的临床疗效。方法计算机检索EMBASE、Pubmed、Cochrane图书馆、中国知网、万方等数据库。收集PFNA与LCP内固定治疗成年股骨粗隆间骨折的随机对照研究(RCT)和临床对照研究(CCT),纳入符合要求的文献。选取手术时间、术中失血量、切口长度、Harris评分优良率、骨折愈合时间、术后并发症作为Meta分析评价指标,并对指标采用Rev Man 5.2软件进行分析。结果共纳入12篇文献,共1 001例研究对象,其中PFNA内固定512例,LCP内固定489例。纳入9篇CCT,3篇RCT。Meta分析结果显示,PFNA组与LCP组相比,缩短了手术时间[MD=-19.39,95%CI(-32.16,-6.63),P<0.05],减少了术中失血量[MD=-125.18,95%CI(-185.76,-64.59),P<0.05],缩短了切口长度[MD=-7.97,95%CI(-8.53,-7.41),P<0.05]。而2组Harris评分优良率[OR=1.26,95%CI(0.87,1.83),P>0.05]、骨折愈合时间[MD=-0.65,95%CI(-1.38,0.08),P>0.05]、术后并发症[OR=0.76,95%CI(0.33,1.74),P>0.05]差异无统计学意义。结论与LCP内固定相比,PFNA内固定在减少术中失血量、缩短手术时间、缩短切口长度方面更具有优势,但二者在Harris评分优良率、术后并发症、骨折愈合时间方面差异无统计学意义。虽然PFNA内固定治疗股骨粗隆间骨折有一定的优势,但在临床上应综合各方面因素而选择最佳的手术方式。

Objective To compare the clinical efficacy of proximal femoral nail antirotation（PFNA） versus locking compression plate（LCP） in the treatment of intertrochanteric fracture in adult by meta-analysis. Methods EMBASE,Pubmed,Cochrane Library,CNKI,Wan Fang Database were searched on computer. Articles of RCT and CCT about PFNA and LCP were collected and enrolled in the study. Time of the operation,blood loss during the operation,length of the incision,Harris score and excellent rate,fracture healing time,postoperative complications were chosen to be indicators of meta- analysis. With software of Rev Man 5.2,all the included results were carefully analyzed. Results A total of 12 articles including 1 001 patients,of which 512 cases were treated with PFNA while 489 cases treated with LCP,were carefully enrolled in the study.Articles selected in the study included 9 CCT and 3 RCT. The results showed that PFNA had advantages over LCP in the aspects of shortening the operation time [MD =-19.39,95%CI（-32.16,-6.63）,P〈0.05],reducing surgical blood loss volume[MD =-125.18,95%CI（-185.76,-64.59）,P〉0.05],reducing the incision length [MD =-7.97,95%CI（-8.53,-7.41）,P〉0.05].However,there were no statistical differences between them in the results of Harris score and excellent rate[ OR =1.26,95%CI（0.87,1.83）,P〉0.05],fracture healing time [MD =-0.65,95%CI（-1.38,0.08）,P〉0.05],postoperative complications [OR =0.76,95%CI（0.33,1.74）,P〉0.05]. Conclusion PFNA has advantages over LCP in the aspects of reducing surgical blood loss volume,shortening the operation time,reducing incision length,but there are no statistical differences between them in the aspects of Harris score and excellent rate,fracture healing time,postoperative complications. Despite PFNA has some advantages in the clinical application,the best surgical treatment should be choose according to various factors in the face of adult patients with intertrochanteric fractures.