侧卧位人工牵引和平卧位牵引床牵引对闭合复位股骨近端防旋髓内钉内固定治疗老年不稳定股骨转子间骨折的比较

Comparison of efficacy of lateral decubitus and supine position in treatment of elderly unstable intertrochanteric fractures with proximal femoral nail antirotation

背景:股骨近端防旋髓内钉具有固定稳定性高、术中创伤小及术后恢复快等优势,被广泛应用于股骨转子间骨折的临床治疗。但目前尚未见对股骨近端防旋髓内钉两种体位方式疗效差异的循证医学对比研究。目的:以Meta分析的方法评价侧卧位人工牵引和平卧位牵引床牵引对闭合复位股骨近端防旋髓内钉内固定治疗老年不稳定型股骨转子间骨折的疗效。方法:计算机检索国内外有关老年股骨转子间骨折使用股骨近端防旋髓内钉闭合复位内固定的相关研究,通过进行文献质量评价,应用Rev Man 5.3分析软件进行Meta分析。结果与结论:(1)共纳入随机对照试验文献8篇,共计661例患者,其中侧卧位人工牵引组330例,平卧位牵引床牵引331例;(2)Meta分析结果显示,侧卧位人工牵引与平卧位牵引床牵引相比,可缩短术前准备时间[MD=-7.58,95%CI(-14.42,-0.74),P<0.05]及手术时间[SMD=-0.81,95%CI(-1.01,-0.61),P<0.000 1],减少切口长度[MD=-1.92,95%CI(-2.17,-1.67),P<0.000 1],减少术中出血量[MD=-24.51,95%CI(-42.22,-6.79),P=0.007<0.01],但增加了术中透视次数[MD=2.82,95%CI(0.91,4.72),P=0.004<0.01],差异均有显著性意义。而2组6个月Harris功能评分差异无显著性意义[MD=0.55,95%CI(-0.77,1.86),P>0.05];(3)结果表明,虽然侧卧位人工牵引股骨近端防旋髓内钉闭合复位内固定治疗老年股骨转子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修复方式。

BACKGROUND： Proximal femoral nail antirotation is widely used in the treatment of intertrochanteric fracture of the femur because of its advantages of high stability, small trauma and quick recovery after operation. However, there is no comparative study on evidence based medicine of the difference in the efficacy between the two postures of proximal femoral nail antirotation.OBJECTIVE： To compare the clinical efficacy of lateral decubitus with manual traction versus supine position with traction bed in treatment of elderly unstable intertrochanteric fractures with proximal femoral nail antirotation by meta-analysis. METHODS： Studies on femoral intertrochanteric fractures in the elderly using closed internal fixation with proximal femoral nail antirotation were retrieved by computer. Quality of the studies was assessed. The meta-analysis was conducted by using the Rev Man 5.3 software. RESULTS AND CONCLUSION：（1） A total of 8 articles including 661 patients, of which 330 cases were treated in lateral decubitus with manual traction while 331 cases treated in supine position with traction bed, were carefully enrolled in the study.（2） The meta-analysis results showed that lateral decubitus had advantages over supine position in shortening operative preparation time [MD=-7.58, 95%CI（-14.42,-0.74）, P 0.05], shortening operation time [SMD=-0.81, 95%CI（-1.01,-0.61）, P 0.000 1], reducing length of incision [MD=-1.92, 95%CI（-2.17,-1.67）, P 0.000 1], reducing surgical blood loss volume [MD=-24.51, 95%CI（-42.22,-6.79）, P=0.007 0.01], increasing the number of X-ray fluoroscopy [MD=2.82, 95%CI（0.91, 4.72）, P=0.004 0.01]. However, there were no statistical differences between them in the results of Harris Hip Score at 6 months [MD=0.55, 95%CI（-0.77, 1.86）, P 0.05].（3） Results suggested that lateral decubitus with manual traction has advantages over supine position with traction bed, but the best surgical position in proximal femoral nail antirotation should be chosen according to various factors in the treatment of intertrochanteric fractures in the elderly.