PFNA与DHS治疗不稳定型股骨粗隆间骨折的Meta分析

Meta-analysis on PFNA and DHS in treatment of unstable intertrochanteric fracture

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)治疗不稳定型股骨粗隆间骨折的临床疗效及安全性。方法计算机检索Medline、EMbase、Pubmed、Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)等数据库,手工检索与骨科相关的文献和会议论文。按照纳入标准,收集所有PFNA与DHS治疗不稳定型股骨粗隆间骨折的随机对照试验,采用RevMan5.1统计软件进行分析。结果纳入19篇随机对照试验,共1 690例患者,其中PFNA内固定871例,DHS内固定819例。与DHS相比,PFNA固定具有创伤小、出血量少、手术时间短、骨折愈合时间及术后卧床时间短、髋关节功能好、术后髋内翻及螺钉切割发生率低的优点,但两者在住院时间、病死率,以及骨折不愈合、内固定断裂、股骨头坏死、股骨颈短缩、股骨干骨折、下肢深静脉血栓、尿路感染等并发症发生率方面比较,差异无统计学意义(P>0.05)。结论所检索的文献表明PFNA内固定治疗不稳定型股骨粗隆间骨折疗效优于DHS内固定。

Objective To evaluate the effects and security of PFNA and DHS in the treatment of unstable intertrochanteric fractures through meta analysis.Methods The randomized controlled trials（RCT）for comparing PFNA and DHS in the treatment of unstable intertrochanteric fracture were retrieved from MEDLINE,EMbase,Pubmed,Cochrane library,CBM,CNKI,VIP databases by computer.The related orthopedic relevant documents and conference papers were collected by manual retrieval.The RevMan5.1statistical software was used for conducting the meta analysis.Results Nineteen RCT were included,involving 1 690 patients,in which 871 cases were treated by using PFNA and 819 cases were treated by using DHS.Compared with DHS,PFNA had the advantages of little trauma,less blood loss,short operation time,short fracture healing time and postoperative bed time,good hip function and low incidence of postoperative coxa vara and screw cutting,but there were no statistical differences in the aspects of length of hospital stay,fatality rate,and incidences of fracture nonunion,breakage of internal fixation,femoral head necrosis,shortening of the femoral neck,femoral shaft fractures,deep vein thrombosis,urinary tract infection and other complications between the two groups（P〈0.05）.Conclusion The retrieved literatures show that PFNA internal fixation is superior to DHS internal fixation in treatment of unstable intertrochanteric fractures.