两种构型空心钉固定股骨颈骨折的荟萃分析

A meta-analysis on two configurations of cannulated screw placement for femoral neck fractures

[目的]采用荟萃分析评价菱形与倒三角排列的空心钉内固定股骨颈骨折的临床疗效。[方法]计算机检索CNKI、维普、万方医学数据库、Sinomed、Pubmed、Embase、Web of Science、和The Cochrane Library等数据库,收集所有关于应用菱形和倒三角空心钉固定股骨颈骨折疗效对比的临床研究,检索时间均为建库至2022年3月。由2位研究者根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.4.软件进行荟萃分析。[结果]最终纳入5项研究,涉及387例患者,其中菱形组178例,倒三角组209例。荟萃结果显示:菱形组术中出血量显著多于倒三角组(P<0.05),末次随访Harris评分显著高于倒三角组(P<0.05),两组的手术时间、骨折不愈合率、股骨头缺血坏死率、退钉率和股骨颈短缩率的差异均无统计学意义(P>0.05)。[结论]菱形组在术后Harris评分优于倒三角组,倒三角组的出血量低于菱形组。两组在骨折不愈合率、股骨头缺血坏死率、退钉率、股骨颈短缩发生率等远期并发症方面无明显差异。

[Objective] To evaluate the clinical efficacy of diamond-shaped(DS) versus inverted triangular(IT) cannulated screw placements for internal fixation of femoral neck fractures by meta-analysis. [Methods] Databases including CNKI, VIP, Wanfang Medical database, Sinomed, Pubmed, Embase, Web of Science, and the Cochrane Library were searched for all clinical studies on the comparison of the efficacy of DS versus IT cannulated screw placement for femoral neck fracture from the establishment of the database to March 2022. After literatures were screened by two researchers, the data were extracted with evaluation of the methodological quality to meet the inclusion and exclusion criteria. RevMan5.4 Software was used for meta-analysis. [Results] A total of 5 articles were enrolled in this study, involving387 patients, including 178 patients in the DS group and 209 patients in the IT group. As results of the meta-analysis, the DS group had significantly greater intraoperative blood loss than the IT group(P<0.05), while the former had significantly higher Harris score at last followup than the latter(P<0.05). However, there were no significant differences in terms of operation time, fracture nonunion rate, femoral head necrosis rate, screw displacement rate and femoral neck shortening rate between the two groups(P>0.05). [Conclusion] Although the DS cannulated screw placement has considerably greater intraoperative blood loose, this screw placement configuration does achieve better outcome in term of Harris score than the inverted triangle configuration. There was no significant difference between the two configurations in fracture nonunion rate, femoral head necrosis rate, screw displacement rate, femoral neck shortening rate and other long-term complications.