动力髋螺钉联合防旋螺钉对比单用空心螺钉治疗成人股骨颈骨折的Meta分析

Dynamic hip screw combined with anti-rotation screw versus cannulated screw alone for femoral neck fracture in adults:a meta-analysis

目的 对比动力髋螺钉(dynamic hip screw, DHS)+防旋螺钉与单用空心螺钉治疗成人股骨颈骨折的有效性与安全性。方法 检索PubMed、Web of Science、Cochrane Library、中国知网、中国生物医学文献数据库、万方、维普数据库中比较DHS+防旋螺钉与单用空心螺钉治疗成人股骨颈骨折的相关文献,检索时限为建库至2022年。采用RevMan 5.3软件进行Meta分析。结果 最终纳入25篇临床研究,包括8篇随机对照试验和17篇观察性研究;英文文献5篇,中文20篇。总共2 099例患者,其中DHS+防旋螺钉组989例,单用空心螺钉组1 110例。Meta分析结果显示,DHS+防旋螺钉组的骨不连发生率[比值比(odds ratio, OR)=0.29,95%置信区间(confidence interval, CI)(0.17,0.48)]、股骨头坏死发生率[OR=0.48,95%CI(0.27,0.88)]、内固定失败率[OR=0.28,95%CI(0.15,0.51)]低于空心螺钉组(P<0.05)。DHS+防旋螺钉组的手术时长[均数差(mean difference,MD)=9.91,95%CI(6.78,13.05)]、切口长度[MD=1.25,95%CI(0.15,2.35)]、Harris评分[MD=6.77,95%CI(4.66,8.88)]大于空心螺钉组(P<0.05)。两组的术中出血量、视觉模拟评分法得分、住院时长、骨折愈合时长差异无统计学意义(P>0.05)。PauwelsⅢ型骨折后DHS+防旋螺钉组的骨不连发生率[OR=0.16,95%CI(0.05,0.50)]低于单用空心螺钉组(P<0.05),两组的股骨头坏死率差异无统计学意义(P>0.05)。结论 对于成人股骨颈骨折,DHS+防旋螺钉相比单用空心螺钉可以降低骨不连发生率、股骨头坏死发生率、内固定失败率,并有更高的Harris评分,但是手术时长和切口长度更长。总之,DHS+防旋螺钉在降低并发症发生率方面比单用空心螺钉更佳。

ObjectiveeTo compare the efficacy and safety of dynamic hip screw(DHS)+anti-rotation screw and cannulated screw alone for femoral neck fracture in adults.Methods PubMed,Web of Science,Cochrane Library,China National Knowledge Infrastructure,SinoMed,Wanfang,and Chongqing VIP database were searched for the literature related to the comparison between DHS+anti-rotation screw and cannulated screw alone for femoral neck fracture in adults from the establishment of databases to 2022.RevMan 5.3 software was used for meta-analysis.Results Finally,25 clinical studies were included,including 8 randomized controlled trials and 17 observational studies,5 in English and 20 in Chinese.There were a total of 2099 patients,including 989 in the DHS+anti-rotation screw group and 1110 in the cannulated screw group.The meta-analysis results showed that the incidence of bone nonunion[odds ratio(OR)=0.29,95%confidence interval(CI)(0.17,0.48)],incidence of femoral head necrosis[OR=0.48,95%CI(0.27,0.88)],failure rate of internal fixation[OR=0.28,95%CI(0.15,0.51)]in the DHS+anti-rotation screw group were lower than those in the cannulated screw group(P<0.05).The surgical duration[mean difference(MD)=9.91,95%CI(6.78,13.05)],incision length[MD=1.25,95%CI(0.15,2.35)],and Harris score[MD=6.77,95%CI(4.66,8.88)]in the DHS+anti-rotation screw group were higher than those in the cannulated screw group(P<0.05).There was no statistically significant difference in intraoperative bleeding volume,Visual Analogue Scale score,hospital stay,and fracture healing time between the two groups(P>0.05).The incidence of bone nonunion in the DHS+anti-rotation screw group after Pauwels type II fracture[OR=0.16,95%CI(0.05,0.50)]was lower than that in the cannulated screw group(P<0.05),and there was no statistically significant difference in the incidence of femoral head necrosis between the two groups(P>0.05).Conclusions For femoral neck fracture in adults,DHS+anti-rotation screw can reduce the incidence of bone nonunion,femoral head necrosis,and internal fixation failure compared with cannulated screw alone,and has a higher Harris score,but the surgical duration and incision are longer.Overall,DHS+anti-rotation screw are better at reducing the incidence of complications than cannulated screws alone.