股骨近端防旋髓内钉联合捆扎内固定治疗股骨转子间骨折有效性和安全性的Meta分析

Clinical outcomes and safety of proximal femoral nail antirotation combined with bundling internal fixation for treatment of intertrochanteric fractures:a meta-analysis

目的:系统评价股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)联合捆扎内固定治疗股骨转子间骨折的有效性和安全性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase、Web of Science和Cochrane Library中关于PFNA联合捆扎内固定和单纯PFNA内固定治疗股骨转子间骨折的对比研究文献,检索时限均为建库至2022年8月8日。试验组采用PFNA联合捆扎内固定治疗,对照组单纯采用PFNA内固定治疗。由2名研究人员依据文献检索及筛选方案筛选出符合要求的文献,并独立进行数据提取和质量评价。采用Stata16.0软件进行Meta分析。结果:共检索到534篇文献,最终纳入12篇文献,共涉及758例患者,其中试验组356例、对照组402例。Meta分析结果显示,试验组手术时间长于对照组[WMD=6.35,95%CI(2.73,9.97)],术中出血量多于对照组[WMD=13.15,95%CI(2.99,23.30)],术后下地负重时间、骨折愈合时间均短于对照组[WMD=-3.03,95%CI(-4.26,-1.81);WMD=-3.21,95%CI(-6.16,-0.25)],末次随访时Harris髋关节评分高于对照组[WMD=5.66,95%CI(3.47,7.85)],并发症发生率低于对照组[OR=0.25,95%CI(0.15,0.42)]。结论:PFNA联合捆扎内固定治疗股骨转子间骨折与单纯PFNA内固定比较,有利于术后早期负重、骨折愈合及髋关节功能恢复,且安全性高,但会增加手术时间和术中出血量。

Objective:To systematically review the clinical outcomes and safety of proximal femoral nail antirotation(PFNA)combined with bundling internal fixation in treatment of intertrochanteric fractures.Methods:All the comparative study articles about PFNA combined with bundling internal fixation versus PFNA internal fixation alone for treatment of intertrochanteric fractures included from database establishing to August 8,2022 were retrieved from the China National Knowledge Internet,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,PubMed,Embase,Web of Science and Cochrane Library through computer.The patients in experiment group were treated with PFNA and bundling internal fixation,while the ones in control group merely with PFNA internal fixation.The articles were retrieved and screened and the information was extracted independently by two researchers according to the inclusion and exclusion criteria.The methodological quality of researches in the included articles was evaluated respectively independently by the same two researchers,and if any disagreement was found between them,discussion was conducted or another researcher was invited for making a final decision,and then a Meta-analysis was conducted by using Stata16.0 software.Results:Five hundred and thirty-four articles were searched out.After screening,12 articles(758 patients)were included in the final analysis,356 patients in experiment group and 402 ones in control group.The results of Meta-analysis revealed that the operative time was longer,the intraoperative blood loss was more,the postoperative weight-bearing walking was earlier,the fracture healing time was shorter,the Harris hip score evaluated at the last follow-up was higher,and the postoperative complication incidence rate was lower in experiment group compared to control group(WMD=6.35,95%CI(2.73,9.97);WMD=13.15,95%CI(2.99,23.30);WMD=-3.03,95%CI(-4.26,-1.81);WMD=-3.21,95%CI(-6.16,-0.25);WMD=5.66,95%CI(3.47,7.85);OR=0.25,95%CI(0.15,0.42)).Conclusion:PFNA combined with bundling internal fixation is conducive to postoperative earlier weight-bearing,fracture healing and hip function recovery with high safety,but can increase the operative time and intraoperative blood loss compared to PFNA alone in treatment of intertrochanteric fractures.