系统评价和Meta分析股骨近端髓内钉与防旋型股骨近端髓内钉治疗股骨转子间骨折的差异

InterTan nail versus proximal femoral nail antirotation for femoral intertrochanteric fractures: a systematic review and meta-analysis

背景:现有研究结论对股骨近端髓内钉与防旋型股骨近端髓内钉治疗股骨转子间骨折常用的疗效差异存在争议。目的:采用系统评价和Meta分析方法评价股骨近端髓内钉与防旋型股骨近端髓内钉治疗股骨转子间骨折的疗效差异。方法:系统检索PubM ed、The Cochrane Library(2016年第4期)、Embase、中国知网、维普期刊数据库、中国生物医学文献服务系统、万方资源数据库中,所有关于股骨近端髓内钉与防旋型股骨近端髓内钉比较治疗股骨转子间骨折的临床对照试验,检索时限为各数据库建库至2016年5月8日。严格按纳入标准筛选文献、评价研究质量、提取数据资料,运用Stata13.1软件进行统计分析。结果与结论:纳入8个随机对照试验和8个非随机对照试验,合计股骨转子间骨折患者1 323例,其中股骨近端髓内钉658例,防旋型股骨近端髓内钉治疗665例。Meta分析结果显示,两种治疗方法在优良率、术中出血量、卧床时间、骨折愈合时间方面相当(P>0.05),股骨近端髓内钉治疗较防旋型股骨近端髓内钉治疗手术时间长[MD=11.51,95%CI(6.41,11.62),P<0.01],但在增加髋关节Harris评分[MD=1.38,95%CI(0.25,2.51),P=0.02]、降低术后并发症发生率[RR=0.54,95%CI(0.44,0.67),P<0.01]方面优于防旋型股骨近端髓内钉治疗。受纳入研究方法学质量影响,上述研究结论需大量临床随机对照研究予以证实,两种治疗措施对不同骨折类型骨折及骨质疏松患者的疗效差异也需进一步研究。

BACKGROUND： The conclusion of current studies about the difference of clinical efficacy between Inter Tan nail and proximal femoral nail antirotation（PFNA） for femoral intertrochanteric fractures is still controversial.OBJECTIVE： To compare the difference in therapeutic efficacy between Inter Tan nail and PFNA for femoral intertrochanteric fractures using systematical review and meta-analysis. METHODS： A computer-based online search was conducted in Pub Med, The Cochrane Library（Issue 4, 2016）, Embase, CNKI, VIP, CBM, and Wan-Fang databases up to May 8, 2016 to screen the relevant controlled trials of InterT an nail versus PFNA for the treatment of femoral intertrochanteric fractures. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extraction from eligible studies was pooled and meta-analyzed using Stata13.1 software. RESULTS AND CONCLUSION： A total of 8 randomized and 8 non-randomized trials involving 1 323 patients were included. There were 658 patients undergoing InterT an nail and 665 patients undergoing PFNA. The meta-analysis results showed that there were no significant differences in excellent rate, intraoperative blood loss, bedridden time, and fracture healing time（P〈0.05）. The operative time in Inter Tan nail group was longer than PFNA group [MD=11.51, 95%CI（6.41,11.62）, P〈0.01]. However, the Inter Tan nail was superior to PFNA in increasing the Harris scores [MD=1.38, 95%CI（0.25, 2.51）, P=0.02], and decreasing the complication rates [RR=0.54, 95%CI（0.44, 0.67）, P〈0.01]. Due to the limitations of the included studies, more high-quality randomized controlled trials are needed to verify the above conclusion. In addition, future studies should focus on the difference in therapeutic efficacy of the two treatments in different fracture types and the osteoporosis patients.