股骨颈动力交叉钉系统与空心螺钉治疗股骨颈骨折疗效的Meta分析

Efficacy of femoral neck system and cannulated screw in treatment of femoral neck fracture:a meta-analysis

目的系统评价股骨颈动力交叉钉系统(FNS)与空心螺钉(CS)治疗成人股骨颈骨折在围术期及恢复期的疗效。方法检索知网、万方、维普、CBM、PubMed、Embase、Cochrane数据库,收集有关2种内固定方案疗效比较的相关文献。采用Review Manager 5.3软件对最终纳入研究的文献进行Meta分析。结果本研究共纳入24篇回顾性队列研究,共1661例,其中FNS组(FNS治疗)为783例,CS组(CS治疗)为878例。FNS组的术中透视次数(MD=-9.69,95%CI:-11.27~-8.11,P<0.01)、完全负重时间(MD=-1.69,95%CI:-2.88~-0.50,P<0.01)、骨折愈合时间(MD=-1.15,95%CI:-1.57~-0.73,P<0.01)、末次随访Harris评分(MD=-1.5,95%CI:2.30~4.59,P<0.01)及股骨头坏死率(OR=0.48,95%CI:0.26~0.91,P=0.02)优均于CS组;但FNS组术中出血量(MD=17.72,95%CI:9.88~25.55,P<0.01)、术区切口长度(MD=0.39,95%CI:0.04~0.73,P=0.03)均大于CS组。2组在手术时间(MD=-3.78,95%CI:-7.95~0.39,P=0.08)、住院总时间(RR=-0.14,95%CI:-0.43~0.14,P=0.32)方面比较,差异无统计学意义。结论FNS治疗成人股骨颈骨折具有术中透视次数少、完全负重时间早、骨折愈合速度快、髋关节Harris评分高等优点,但与CS相比,术中出血量较多及术区切口较大。

Objective To evaluate the efficacy of femoral neck system(FNS)and cannulated screw(CS)in the treatment of femoral neck fracture in adults during perioperative and conjunctional periods.Methods By searching CNKI,Wanfang,VIP,CBM,PubMed,Embase and Cochrane databases,relevant literatures on the efficacy comparison of the two internal fixation regimens were collected.Review Manager 5.3 software was used to conduct a meta-analysis of the literature finally included in the study.Results A total of 24 retrospective cohort studies were included in this study,with a total of 1661 participants,including 783 participants in the FNS group(FNS treatment)and 878 participants in the CS group(CS treatment).In the FNS group,intraoperative fluoroscopy times(MD=-9.69,95%CI,-11.27 to-8.11,P<0.01),complete weight-bearing time(MD=-1.69,95%CI,-2.88 to-0.50,P<0.01),fracture healing time(MD=-1.15,95%CI,-1.57 to-0.73,P<0.01),Harris score at last follow-up(MD=-1.5,95%CI,2.30 to 4.59,P<0.01)and femoral head necrosis rate(OR=0.48,95%CI,0.26 to 0.91,P=0.02)were superior in the CS group;however,intraoperative blood loss(MD=17.72,95%CI,9.88 to 25.55,P<0.01)and incision length(MD=0.39,95%CI,0.04 to 0.73,P=0.03)in the FNS group were higher than those in the CS group.There were no significant differences between the two groups in terms of operation time(MD=-3.78,95%CI,-7.95 to 0.39,P=0.08)and total hospitalization days(RR=-0.14,95%CI,-0.43 to 0.14,P=0.32).Conclusion FNS in the treatment of adult femoral neck fractures has the advantages of less intraoperative fluoroscopy,earlier complete weight-bearing time,faster fracture healing and higher hip Harris score,but compared with CS,it has more intraoperative blood loss and larger incision area.