Parker M J, Handoll H H, Chinoy M A
Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA.
Cochrane Database Syst Rev. 2001(2):CD000339. doi: 10.1002/14651858.CD000339.
Extramedullary fixation of hip fractures refers to the application of a plate and screws to the lateral side of the proximal femur.
To compare different types of extramedullary fixation implants for the surgical treatment of extracapsular hip fracture in adults.
We searched the Cochrane Musculoskeletal Injuries Group specialised register and reference lists of relevant articles. Date of the most recent search: January 2001.
All randomised or quasi-randomised trials comparing extramedullary implants used in the fixation of extracapsular hip fracture in adults.
Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, data from comparable trials were pooled.
A newly identified trial investigating the RAB plate (a fixed angle blade plate with an oblique connecting strut) is included in this update. All eight included trials (involving 1173 participants) had methodological flaws which may have resulted in serious bias. Three trials involving 355 patients compared a fixed nail plate (Jewett or McLaughlin) with the sliding hip screw (SHS). The limited data presented indicated an increased risk of fixation failure outcomes for fixed nail plates. The two trials, involving 433 patients, comparing the RAB plate with the SHS had contrasting results, notably in terms of operative complications, fixation failure and anatomical restoration. One trial involving 100 patients compared the Pugh nail and the SHS. There was no significant difference between implants for the outcome measures reported. One trial involving 178 patients with 182 fractures, compared the Medoff plate with the SHS. A significantly higher mean operative blood loss and longer mean operative time were reported for the Medoff plate. There was however a tendency to a lower risk of fixation failure for unstable trochanteric fractures fixed with the Medoff plate. One trial involving 107 patients with subtrochanteric fractures compared the Medoff plate with three different screw plate systems. There was a tendency to a lower fixation failure rate for the Medoff plate, but no evidence for differences in longer-term outcomes.
REVIEWER'S CONCLUSIONS: The fixed nail plate has higher risks of implant breakage and fixation failure than the SHS. Though insufficient evidence on other outcomes is available from randomised trials, the increased fixation failure rate is a major consideration and thus the SHS appears preferable. Insufficient information is available to draw firm conclusions of the clinical significance of differences between the SHS and either the RAB plate, the Pugh nail or the Medoff plate.
髋部骨折的髓外固定是指在股骨近端外侧应用钢板和螺钉。
比较不同类型的髓外固定植入物用于成人囊外髋部骨折的手术治疗效果。
我们检索了Cochrane肌肉骨骼损伤组专业注册库及相关文章的参考文献列表。最近一次检索日期为2001年1月。
所有比较用于成人囊外髋部骨折固定的髓外植入物的随机或半随机试验。
两名评价者独立使用十项量表评估试验质量，并提取数据。向所有试验者寻求更多信息。在适当且可行的情况下，合并可比试验的数据。
本次更新纳入一项新识别的研究RAB钢板（一种带有斜向连接支柱的角钢板）的试验。纳入的所有八项试验（涉及1173名参与者）均存在方法学缺陷，可能导致严重偏倚。三项涉及355例患者的试验比较了固定钉板（Jewett或McLaughlin）与滑动髋螺钉（SHS）。所呈现的有限数据表明固定钉板出现固定失败结果的风险增加。两项涉及433例患者的试验比较了RAB钢板与SHS，结果相互矛盾，尤其是在手术并发症、固定失败和解剖复位方面。一项涉及100例患者的试验比较了Pugh钉与SHS。报告的结局指标在植入物之间无显著差异。一项涉及178例患者182处骨折的试验比较了Medoff钢板与SHS。Medoff钢板的平均手术失血量显著更高，平均手术时间更长。然而，使用Medoff钢板固定不稳定转子间骨折时，固定失败风险有降低趋势。一项涉及107例转子下骨折患者的试验比较了Medoff钢板与三种不同的螺钉钢板系统。Medoff钢板的固定失败率有降低趋势，但无证据表明长期结局存在差异。
固定钉板比SHS有更高的植入物断裂和固定失败风险。尽管随机试验中关于其他结局的证据不足，但固定失败率增加是一个主要考虑因素，因此SHS似乎更可取。关于SHS与RAB钢板、Pugh钉或Medoff钢板之间差异的临床意义，现有信息不足以得出确切结论。
