股骨转子间骨折内固定失败因素的荟萃分析

A meta-analysis on failure of proximal femoral nail anti-rotation for femoral intertrochanteric fractures

[目的]采用荟萃分析评价股骨转子间骨折股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定术后失败的因素.[方法]计算机检索中国知网(CNKI)、万方、Pubmed等数据库相关文献并提取数据,采用Review Manager 5.3软件进行荟萃分析.[结果]共纳入14篇文献,其中中文文献11篇,英文文献3篇,均为回顾性病例对照研究.所有患者均采用PFNA内固定治疗,共2477例,内固定术后失败共333例,所有病例术后随访至少6个月.影响PFNA内固定术后失败的影响因素包括,骨折稳定性(OR=20.94,95%CI:13.45~32.61,P<0.001)、骨折复位质量(OR=9.68,95%CI:4.85~19.3,P<0.001)、尖顶距(OR=3.98,95%CI:2.71~5.84,P<0.001)、骨质疏松(OR=2.88,95%CI:2.01~4.15,P<0.001)、外侧壁完整性(OR=5.40,95%CI:3.36~8.70,P<0.001)、合并内科疾病(OR=3.10,95%CI:1.75~5.49,P<0.001)、唑来膦酸使用(OR=0.47,95%CI:0.26~0.85,P=0.01).[结论]骨折稳定性、骨折复位质量、尖顶距、骨质疏松、外侧壁完整性和合并内科疾病是PFNA内固定术后失败的危险因素,而唑来膦酸的使用为保护性因素.

[Objective]To evaluate the factors related to proximal femoral nail anti-rotation(PFNA)failure for internal fixation of intertrochanteric fractures by meta-analysis.[Methods]Relevant literatures were retrieved from CNKI,Wanfang,Pubmed and other databases,and the data were extracted.Review Manager 5.3 software was used for meta-analysis.[Results]A total of 14 literatures were included,including 11 papers in Chinese and 3 in English,which all were retrospective case-control studies.All patients(2477 cases)in the literatures were treated with PFNA,and followed up for 6 months at least,and 333 patients of them proved of internal fixation failed.The factors related to postoperative failure of PFNA were as follows:fracture stability(OR=20.94,95%CI:13.45~32.61,P<0.001),fracture reduction quality(OR=9.6&95%CI:4.85-19.3,P<0.001),tip-apex distance(OR=3.9&95%CI:2.71-5.84,P<O.001),osteoporosis(OR=2.8&95%CI:2.01~4.15,PvO.001),lateral wall integrity(OR=5.40,95%CI:3.36~8.70,P<O.001),complicated with medical diseases(OR==3.10,95%CI:1.75~5.49,P<0.001),the zoledronate used(OR=0.47,95%CI:0.26~0.85,P=0.01).[Conclusion]Fracture stability,fracture reduction quality,tip-apex distance,osteoporosis,lateral wall integrity and associated medical diseases are the risk factors for PFNA failure,whereas using zoledronate is a protective factor.