经皮加压钢板与动力髋螺钉治疗股骨转子间骨折的Meta分析

A meta- analysis of percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric hip fractures

[目的]对经皮加压钢板(PCCP)与动力髋螺钉(DHS)内固定治疗股骨转子间骨折疗效与并发症进行评价。[方法]按照Cochrane系统评价的方法,计算机检索下列数据库:Medline、Pubmed、SPINGER、John Wiley、Science Direct、EBSCO、CNKI、万方数数据库,并采用手工检索等方法收集文献。检索时间为1998年1月~2013年8月。收集所有相关随机对照试验,采用Cochrane协作网提供的软件Revman 5.1进行Meta分析。[结果]经过筛选,共纳入5个临床随机对照试验463例患者。Meta分析显示PCCP组与DHS组在手术时间(95%CI:-26.01~4.05,P=0.15)、住院时间(95%CI:-1.79~1.25,P=0.73)、死亡率(95%CI:0.37~1.02,P=0.06)、置入物相关并发症(95%CI:0.29~1.82,P=0.49)和再手术率(95%CI:0.41~3.05,P=0.83)上无明显统计学差异。但两组患者出血量(95%CI:-173.84^-4.81,P=0.04)和输血量(95%CI:-0.53^-0.07,P=0.01)有明显差异,PCCP组较DHS组明显减少。[结论]PCCP与DHS相比能减少出血和输血量,但在其他方面基本相同。由于病例数的限制,尚需要更多更高质量的临床随机对照试验来评价PCCP的效果。

[ Objective] To estimate the outcomes and complications of the PCCP versus dynamic hip screw （DHS） fixation for intertrechanteric fractures. [ Method] In order to collecting controlled trials on PCCP and DHS in treatment of intertrochan- teric fractures, MEDLINE, Pubmed, SPRINGER, John Wiley, Science Direct, EBSCO, CNKI and WANGFANG were searched by computer,manual search of related journals was also performed. Time span was from January 1998 to August 2013. Main out- comes were collected and analyzed using the RevMan 5.1 version. [ Result] Five randomized controlled trials involving a total 463 patients were included. Compared with DHS, PCCP had similar operation time （95% CI： -26. 01 -4.05, P = 0. 15 ）, length of hospitalization （95% CI： - 1.79 - 1.25, P = 0.73 ）, mortality （ 95% CI ： 0.37 - 1.02, P = 0.06 ）, incidence of im- plant - related complications （ 95 % C1：0.29 - 1.82, P = 0.49 ）, and reoperation rate （ 95 % CI： 0.41 - 3.05, P = 0. 83 ）. But blood loss （95% CI： -173.84 --4.81 ,P=0.04） and transfusion need （95% CI： -0.53 --0.07,P=0.01） significantly favored the PCCP. [ Conclusion ] The PCCP was associated with reduced blood loss and less transfusion need, but similar to DHS in other respects. Owing to the limitations of the number of patients, more high - quality RCTs are still needed to assess the clinical efficiency of PCCP.