Parker M J, Handoll H H G
Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK PE3 6DA.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004961. doi: 10.1002/14651858.CD004961.pub3.
Intramedullary nails may be used for the surgical fixation of extracapsular hip fractures in adults. They may be inserted from the top (cephalocondylic) or from the bottom (condylocephalic) end of the femur.
To compare different types or design modifications of intramedullary nails used in the fixation of extracapsular hip fractures.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles.
All randomised or quasi-randomised trials comparing different types of intramedullary nails or modifications to the design of intramedullary nails in the treatment of extracapsular hip fractures in adults.
Both authors independently assessed trial quality and extracted data. Additional information was sought from all trialists.
Six studies, involving a total of 1071 predominantly female and older people with mainly unstable trochanteric fractures, were included. Allocation concealment was likely in one trial, not described in three and not done in the other two trials. Four studies, with 910 participants, compared the proximal femoral nail with the Gamma nail. Though there was increased risk of comminution (fragmentation) at the fracture site when inserting a Gamma nail, there was no statistically significant difference in operative fracture of the femur (1/455 versus 5/455; relative risk 0.33, 95% confidence interval 0.07 to 1.63). No notable differences were seen between implants for fracture healing complications, reoperations and other post-operative complications. Pooled data showed no significant difference between implants for mortality (relative risk 1.08, 95% confidence interval 0.82 to 1.41) or function assessment outcomes. One study, with 80 participants, found no differences between a gliding nail versus a standard Gamma nail. Another study, with 81 participants, found no difference between a dynamically versus a statically locked intramedullary hip screw.
AUTHORS' CONCLUSIONS: The limited evidence from the randomised trials undertaken to date is insufficient to determine whether there are important differences in outcome between different designs of intramedullary nails used in the internal fixation of extracapsular hip fractures. Given the evidence of superiority of the sliding hip screw compared with intramedullary nails for extracapsular hip fractures, further studies comparing different designs of intramedullary nails are not a priority. Any new design should be evaluated in a randomised comparison with the sliding hip screw.
髓内钉可用于成人髋关节囊外骨折的手术固定。它们可从股骨的上端（头髁型）或下端（髁头型）插入。
比较用于固定髋关节囊外骨折的不同类型或设计改良的髓内钉。
我们检索了Cochrane骨、关节和肌肉创伤组专业注册库（2006年3月）、Cochrane对照试验中心注册库（Cochrane图书馆2006年第1期）、MEDLINE、EMBASE、英国国家研究注册库、几本骨科杂志、会议论文集以及文章的参考文献列表。
所有比较不同类型髓内钉或髓内钉设计改良在治疗成人髋关节囊外骨折中的随机或半随机试验。
两位作者独立评估试验质量并提取数据。向所有试验者寻求了更多信息。
纳入了6项研究，共1071名参与者，主要为女性和老年人，主要是不稳定型转子间骨折。一项试验可能采用了分配隐藏，三项试验未描述，另外两项试验未进行分配隐藏。四项研究，共910名参与者，比较了股骨近端髓内钉和Gamma钉。虽然插入Gamma钉时骨折部位粉碎（骨折块形成）的风险增加，但股骨手术骨折方面无统计学显著差异（1/455对5/455；相对风险0.33，95%置信区间0.07至1.63）。在骨折愈合并发症、再次手术及其他术后并发症方面，不同植入物之间未见明显差异。汇总数据显示，不同植入物在死亡率（相对风险1.08，95%置信区间0.82至1.41）或功能评估结果方面无显著差异。一项有80名参与者的研究发现，滑动钉与标准Gamma钉之间无差异。另一项有81名参与者的研究发现，动力锁定与静力锁定髓内髋螺钉之间无差异。
迄今为止进行的随机试验提供的有限证据不足以确定用于髋关节囊外骨折内固定的不同设计髓内钉在疗效上是否存在重要差异。鉴于有证据表明滑动髋螺钉在治疗髋关节囊外骨折方面优于髓内钉，进一步比较不同设计髓内钉的研究并非当务之急。任何新设计都应与滑动髋螺钉进行随机对照评估。
