股骨颈动力交叉钉系统与空心加压螺钉治疗成人股骨颈骨折的有效性与安全性的Meta分析

Meta-analysis of the Effectiveness and Safety of Femoral Neck System and Cannulated Compression Screw in the Treatment of Adult Femoral Neck Fractures

目的:比较股骨颈动力交叉钉系统(FNS)与空心加压螺钉(CCS)治疗成人股骨颈骨折的临床疗效差异。方法:在中国知网(CNKI)、中国生物医学文献(CBM)、维普(VIP)、万方、Embase、PubMed、Web of Science及The Cochrane Library中,检索建库至2022年6月发表的关于FNS与CCS治疗成人股骨颈骨折术后疗效的相关文献。严格筛选文献并提取相关数据,采用REVMAN5.3软件进行分析。结果:共纳入17篇相关文献,共1012例成人股骨颈骨折患者,其中FNS组488例,CCS组524例;Meta分析结果显示:术中出血量(MD=21.8,P<0.05)、骨折愈合时间(SMD=-0.52,P<0.05)、术后远期(≥12个月)髋关节Harris评分(MD=3.52,P<0.05)、术后部分负重时间(MD=-2.02,P<0.05)、术后完全负重时间(MD=-1.83,P<0.05)、术后Barthel指数(MD=4.47,P<0.05)、术后股骨颈缩短长度(MD=-2.54,P<0.05)及术后并发症(OR=0.33,P<0.05)差异具有统计学意义;而FNS组和CCS组术后近期(6个月)髋关节Harris评分(MD=1.72,P=0.18)差异无统计学意义。结论:FNS是治疗成人股骨颈骨折的一种有效手术方式,在术后Barthel指数、术后远期(≥12个月)髋关节Harris评分、股骨颈缩短长度、骨折愈合时间、术后负重时间及术后并发症方面均优于CCS。

Objective:To compare the clinical efficacy of femoral neck system(FNS)and cannulated compression screw(CCS)in treating young and middle-aged femoral neck fractures.Methods:The literature related to the efficacy of FNS versus CCS for the treatment of postoperative femoral neck fractures in adults published in China Knowledge Network(CNKI),China Biomedical Literature(CBM),Vipers(VIP),Wanfang,Embase,PubMed,Web of Science,and The Cochrane Library was searched for the period from the establishment of the database to June 2022.Literature was strictly screened,and relevant data were extracted and analyzed using REVMAN5.3 software.Results:Seventeen studies were included in the meta-analysis,including 1012 adult patients with femoral neck fractures,488 cases in the FNS group,and 524 cases in the CCS group.The results of the meta-analysis showed that:In the FNS group,intraoperative blood loss(MD=21.8,P<0.05),fracture healing time(SMD=-0.52,P<0.05),distant(≥12 months)postoperative Harris hip score(MD=3.52,P<0.05),postoperative partial weight-bearing time(MD=-2.02,P<0.05),postoperative full weight-bearing time(MD=-1.83,P<0.05),Barthel index(MD=4.47,P<0.05),femoral neck shortening length(MD=-2.54,P<0.05)and postoperative complication rate(OR=0.33,P<0.05)were statistically significant.However,there was no significant difference in Harris hip score(MD=1.70,P=0.18)between the FNS group and CCS group in recent postoperative(6 months)Harris hip score(MD=1.72,P=0.18)。Conclusion:For femoral neck fractures in adults,FNS is an effective surgical method.It is superior to CCS in terms of postoperative Barthel index,distant(≥12 months)postoperative Harris hip score,femoral neck shortening length,fracture healing time,postoperative weight-bearing time,and postoperative complication rase.