防旋型股骨近端髓内钉与动力髋螺钉修复老年股骨转子间骨折的Meta分析

摘要

背景：现在大量的研究已经证实与动力髋螺钉相比，防旋型股骨近端髓内钉修复老年股骨转子间骨折具有较好的疗效，但具体的优越性目前尚无明确结论。目的：采用Meta分析的方法，将防旋型股骨近端髓内钉与动力髋螺钉对老年股骨转子间骨折的修复效果进行比较。方法：通过计算机检索2011至2015年维普数据库、万方数据库、PubMed数据库、Embase数据库等，搜集有关防旋型股骨近端髓内钉与动力髋螺钉修复老年股骨转子间骨折的随机对照试验，选择手术时间、术中出血量、住院时间、骨折愈合时间、Harris评分、切口长度、术后下床行走时间作为 Meta分析评价的指标，采用 RevMan 5.3进行数据分析。结果与结论：最终纳入9篇文献，共纳入858例老年股骨转子间骨折患者，文献发表时间为2011至2015年，均为中文文献。Meta 分析结果显示，与动力髋螺钉相比，防旋型股骨近端髓内钉修复老年股骨转子间骨折可以有效减少手术时间、出血量、住院时间、骨性愈合时间及切口长度，并且术后下地活动时间较早，可获得较好的髋关节功能恢复。提示与动力髋螺钉相比，防旋型股骨近端髓内钉修复老年股骨转子间骨折具有一定的优越性，在患者及所在医院条件允许的情况下可以优先选择防旋型股骨近端髓内钉修复老年股骨转子间骨折。%BACKGROUND:Now a lot of studies have confirmed that in contrast with the dynamic hip screw, the proximal femoral nail anti-rotation has a better therapeutic effect on the treatment of intertrochanteric fractures in the elderly, but there is no definite conclusion on the specific superiority at present. OBJECTIVE:To compare the curative effects of proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture using a meta-analysis. METHODS: We searched VIP database, Wanfang database, PubMed database and Embase database from 2011 to 2015, and colected randomized controled trials on proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture. Operation time, intraoperative blood loss, hospital stays, fracture healing time, Harris score, length of incision, bed time walking after the operation were used as evaluation indexes of meta analysis. Data were analyzed using RevMan 5.3 software. RESULTS AND CONCLUSION:In the end, we used 9 literatures, which contained 858 patients of intertrochanteric fractures in the elderly. The time of publication was from 2011 to 2015, and al of them were published in Chinese. The results of Meta-analysis showed that, compared with dynamic hip screw, proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly could effectively reduce operation time, blood loss, hospital stays, fracture healing time, length of incision and the time of walking after the operation was earlier, and it could obtain better recovery of hip function. We can point out that compared with dynamic hip screw, proximal femoral nail anti-rotation has certain advantages in the treatment of intertrochanteric fractures in the elderly. In some conditions, the patients and the hospitals can give priority to choose the proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly.