切开复位内固定联合带血供骨瓣移植与单纯复位内固定治疗股骨颈骨折术后并发症比较的系统评价

Postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures： a systematic review

目的比较切开复位内固定联合带血供骨瓣移植与单纯复位内固定治疗股骨颈骨折的术后并发症发生情况。方法查询中国知网、万方数据库等中文数据库，以及Pubmed、EMBASE、GoogleScholar等英文数据库，检索文献时间范围：2000年1月1日至2017年10月31日。检索有关比较切开复位内固定联合带血供骨瓣植骨术（联合手术组）与单纯复位内固定术（内固定组）治疗股骨颈骨折效果的文献，提取术后骨折不愈合及股骨头缺血性坏死数据。运用Stata12．0软件进行统计分析，以相对危险度（RR）及相应95％可信区间（CI）评价2种手术方式治疗股骨颈骨折的术后并发症情况。结果共纳入23篇研究，包含2162例患者，其中联合手术组1048例，内固定组1114例。Meta分析结果显示：联合手术组患者术后骨折不愈合率低于内固定组患者[RR=0．27，95％CI（0．19，0．38），P〈0．001]，术后股骨头缺血性坏死发生率也低于内固定组患者[RR=0．31，95％c，（0．24，0．42），P〈0．001]。结论与传统复位内固定术相比，切开复位内固定联合带血供骨瓣植骨术治疗股骨颈骨折术后骨折不愈合率和股骨头缺血性坏死率低。

Objective To systematically evaluate the postoperative complications following open reduction and internal fixation combined with vascularized bone flap graft versus only reduction and internal fixation for femoral neck fractures. Methods CNKI, Wan Fang Chinese database, Pubmed, EMBASE and Google Scholar English database were searched for the randomized controlled trials from January 1, 2000 through October 31, 2017 which compared open reduction and internal fixation combined with vascularized bone flap graft （combined surgery group） with only reduction and internal fixation （simple surgery group） for femoral neck fractures. The data concerning postoperative nonunion and avascular necrosis of the femoral head were extracted. The 2 surgical treatments of the patients with femoral neck fracture were compared in terms of the 2 complications. Statistical analyses were conducted using software Stata 12 by relative risk （RR） and corresponding 95% confidence intervals （95% CI） . Results According to our inclusion and exclusion criteria, a total of 23 studies were included, involving 2, 162 cases （1,048 cases receiving combined surgery and 1, 114 cases simple surgery）. The Meta analyses showed that the fracture nonunion rate for the combined surgery group was significantly lower than that for the simple surgery group [ RR = 0. 27,95% CI（0. 19, 0. 38）, P 〈 0. 001 ] and the rate of avascular necrosis was also significantly lower for the former than for the latter [RR=0.31, 95% CI（0.24, 0.42）, P 〈 0.001]. Conclusion In the treatment of femoral neck fractures, open reduction and internal fixation combined with vascularied bone graft may lead to lower rates of nonunion and avascular necrosis of the femoral head than simple open reduction and internal fixation.