外侧壁重建对髓内钉治疗A3型股骨转子间骨折疗效影响的meta分析

Efficacy of lateral wall reconstruction during intramedullary nailing of type A3 femoral intertrochanteric fractures:a meta-analysis

目的:通过meta分析比较髓内钉联合外侧壁重建与单纯髓内钉治疗A3型股骨转子间骨折临床疗效的差异。方法:检索2004年1月至2022年12月中国知网、维普网、万方数据库、Embase、Pubmed、Web of Science、Cochrane Library数据库关于髓内钉联合外侧壁重建与单纯髓内钉治疗A3型股骨转子间骨折的对照研究,严格评价文献质量后提取相关数据。运用RevMan5.3软件进行meta分析。结果:共纳入9篇队列研究文献,其中英文1篇,中文8篇,均为中国学者的研究。共466例A3型股骨转子间骨折患者,其中髓内钉联合外侧壁重建组214例,单纯髓内钉组252例。Meta分析结果显示,与单纯髓内钉组患者相比,髓内钉联合外侧壁重建组患者虽然手术时间更长[均数差(MD)=14.20,95%置信区间(95%CI):10.76~17.67,P<0.001],术中出血量更多(MD=26.06,95%CI:13.52~38.60,P<0.001),但其骨折愈合时间更短(MD=−2.37,95%CI:−3.38~−1.35,P<0.001),内固定失败率更低[比值比(OR)=0.17,95%CI:0.08~0.36,P<0.001],术后并发症发生率更低(OR=0.19,95%CI:0.10~0.39,P<0.001),末次随访Harris评分更高(MD=7.14,95%CI:5.11~9.16,P<0.001),末次随访Harris优良率更高(OR=8.17,95%CI:2.60~25.65,P<0.001)。两组患者骨折复位优良率、尖顶距、术后下地时间、骨不愈合率差异均无统计学意义(P均>0.05)。结论:髓内钉联合外侧壁重建治疗A3型股骨转子间骨折虽然手术时间较长、术中出血量较多,但可以缩短骨折愈合时间、减少并发症,同时更好地改善患者髋关节功能。。

Objective:To compare the clinical efficacy of intramedullary nail combined with lateral wall reconstruction and intramedullary nail alone in the treatment of type A3 femoral intertrochanteric fractures using meta-analysis.Methods:Controlled studies from January 2004 to December 2022 were searched in the CNKI,VIP,Wanfang,Embase,PubMed,Web of Science,and Cochrane Library databases for comparisons between intramedullary nail combined with lateral wall reconstruction and intramedullary nail alone in the treatment of type A3 femoral intertrochanteric fractures.After rigorously evaluating the quality of the literature,relevant data were extracted.RevMan5.3 software was used for meta-analysis.Results:This study included nine cohort studies,one in English and eight in Chinese,all conducted by Chinese scholars.It involved 466 patients with type A3 femoral intertrochanteric fractures,with 214 cases treated by intramedullary nail combined with lateral wall reconstruction and 252 cases by intramedullary nail alone.The meta-analysis revealed that compared to patients in the intramedullary nail alone group,those in the intramedullary nail combined with lateral wall reconstruction group had a longer operative time[mean difference(MD)=14.20,95% confidence interval(95%CI):10.76-17.67,P<0.001]and greater intraoperative blood loss(MD=26.06,95%CI:13.52-38.60,P<0.001).However,the fracture healing time was shorter(MD=−2.37,95%CI:−3.38-−1.35,P<0.001),the failure rate of internal fixation was lower[odds ratio(OR)=0.17,95%CI:0.08-0.36,P<0.001]and the incidence of postoperative complications was lower(OR=0.19,95%CI:0.10-0.39,P<0.001).Additionally,the Harris hip score at the last follow-up was higher(MD=7.14,95%CI:5.11-9.16,P<0.001),and the excellent and good rate of the Harris at the last follow-up was higher(OR=8.17,95%CI:2.60-25.65,P<0.001).There were no statistically significant differences between the two groups in terms of fracture reduction rate,tip-apex distance,postoperative weight-bearing time,or nonunion rate(P>0.05).Conclusions:Although the surgical procedure of lateral wall reconstruction combined with intramedullary nail fixation for type A3 femoral intertrochanteric fractures results in a longer operative time and increased intraoperative blood loss,it can effectively shorten fracture healing time,reduce complications,and improve hip joint function.