富血小板血浆联合空心螺钉内固定治疗股骨颈骨折疗效的Meta分析

Meta-analysis of the efficacy of platelet-rich plasma combined with cannulated screw fixation for the treatment of femoral neck fracture

背景:大多数研究报道了富血小板血浆在促进和改善骨愈合方面的有效性,但由于方法、随访和研究设计的局限性,仍然有许多骨科医师对富血小板血浆联合空心螺钉治疗骨折与骨不连的临床效果存在争议和怀疑。目的:通过Meta分析系统评估富血小板血浆联合空心钉内固定和单纯空心钉内固定治疗股骨颈骨折的疗效差异。方法:利用Cochrane图书馆、PubMed、万方医学网、中国知网、中国期刊全文数据库搜索并收集采用富血小板血浆联合空心螺钉内固定和空心螺钉内固定治疗股骨颈骨折的临床随机对照试验。分别由2名评价者对纳入的研究进行独立的质量评价、数据提取并进行互相核对,运用RevMan 5.3软件对收集的相关数据进行Meta分析。结果与结论:①经过筛选共选择了7篇临床随机对照试验进行Meta分析,共760例患者,其中富血小板血浆联合空心螺钉内固定治疗380例,空心螺钉内固定治疗380例;②Meta分析显示:富血小板血浆联合空心螺钉内固定治疗股骨颈骨折的骨折愈合时间短于空心螺钉内固定治疗[MD=-1.86,95%CI(-2.97,-0.75),P=0.001],骨折愈合率高于空心螺钉内固定治疗[OR=6.51,95%CI(3.36,12.62),P <0.000 01],骨坏死率低于空心螺钉内固定治疗[OR=0.25,95%CI(0.15,0.44),P <0.000 01],术后1,3,6,9,12个月的Harris评分均高于空心螺钉内固定治疗[MD=4.95,95%CI(4.12,5.77),P <0.000 01;MD=19.78,95%CI(18.45,21.11),P <0.000 01;MD=17.16,95%CI(10.39,23.92),P <0.000 01;MD=12.66,95%CI(10.60,14.71),P <0.000 01;MD=10.17,95%CI(5.98,14.36),P <0.000 01];③结果表明,富血小板血浆联合空心螺钉内固定治疗股骨颈骨折的疗效显著优于单纯空心螺钉内固定治疗,联合治疗可以加速骨折愈合、提高愈合率、降低坏死率、促进术后髋关节功能的恢复。

BACKGROUND: Numerous studies have reported the effectiveness of platelet-rich plasma in promoting and improving bone healing. However, due to the limitations of methods, follow-up and study design, many orthopedicians still doubt the clinical effect of platelet-rich plasma combined with cannulated screw fixation in the treatment of fracture and nonunion. OBJECTIVE: To evaluate the difference in efficacy between platelet-rich plasma combined with cannulated screw fixation and simple cannulated screw fixation in the treatment of femoral neck fracture using meta-analysis system. METHODS: The Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search and collect clinical randomized controlled trials of platelet-rich plasma combined with cannulated screw fixation and cannulated screw fixation for the treatment of femoral neck fractures. Two reviewers independently evaluated the quality of the included studies, extracted data and checked each other. Meta-analysis was utilized to analyze the collected data with RevMan 5.3 software. RESULTS AND CONCLUSION:(1) Seven clinical randomized controlled trials were selected for meta-analysis, totally 760 patients. There were 380 cases undergoing platelet-rich plasma combined with cannulated screw fixation and 380 cases undergoing cannulated screw fixation.(2) The meta-analysis showed that compared with the cannulated screw fixation group, fracture healing time was shorter [MD=-1.86, 95%CI(-2.97,-0.75), P=0.001];healing rate was higher [OR=6.51, 95%CI(3.36, 12.62), P < 0.000 01];necrosis rate was lower [OR=0.25, 95%CI(0.15, 0.44), P < 0.000 01];Harris scores at 1, 3, 6, 9, and 12 months postoperatively were higher [MD=4.95, 95%CI(4.12, 5.77), P < 0.000 01;MD=19.78, 95%CI(18.45, 21.11), P < 0.000 01;MD=17.16, 95%CI(10.39, 23.92), P < 0.000 01;MD=12.66, 95%CI(10.60, 14.71), P < 0.000 01;MD=10.17, 95%CI(5.98, 14.36), P < 0.000 01] in the platelet-rich plasma combined with cannulated screw fixation group.(3) Platelet-rich plasma combined with cannulated screw fixation for femoral neck fracture is more effective than that of cannulated screw fixation alone. Combined treatment can accelerate the fracture healing of patients, improve the healing rate, reduce necrosis rate, and promote the recovery of postoperative hip joint function.