Yu Jiajie, Zhang Chao, Li Ling, Kwong Joey S W, Xue Li, Zeng Xiantao, Tang Li, Li Youping, Sun Xin
Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China, 610041.
Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Hubei, China, 442000.
Sci Rep. 2015 Dec 11;5:18195. doi: 10.1038/srep18195.
The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to address this important issue. We searched PubMed, EMBASE and CENTRAL for RCTs that compared different internal fixation implants in patients with intertrochanteric fracture at 6-month follow-up or longer. We ultimately included 43 trials enrolling 6911 patients; most trials were small in sample sizes and events. Their risk of bias was generally unclear due to insufficient reporting. Because of these, no statistically significant differences were present from most of the comparisons across all the outcomes, and no definitive conclusions can be made. However, a number of trials compared two commonly used internal fixation strategies, gamma nail (GN) and sliding hip screw (SHS). There is good evidence suggesting that, compared to SHS, GN may increase the risk of cut out (OR = 1.87, 95% CI, 1.08 to 3.21), re-operation (OR = 1.61, 95% CI, 1.02 to 2.53), intra-operative (OR = 3.14, 95% CI, 1.34 to 7.35) and later fractures (OR = 3.67, 95% CI, 1.37 to 9.83). Future randomized trials or observational studies that are carefully designed and conducted are warranted to establish the effects of alternative internal fixation strategies for intertrochanteric fracture.
股骨转子间骨折术后内固定策略的相对疗效仍不明确。我们进行了一项随机对照试验（RCT）的系统评价和荟萃分析，以解决这一重要问题。我们在PubMed、EMBASE和CENTRAL中检索了比较不同内固定植入物治疗股骨转子间骨折患者且随访6个月或更长时间的RCT。我们最终纳入了43项试验，共6911例患者；大多数试验的样本量和事件数量较少。由于报告不足，其偏倚风险通常不明确。因此，所有结局的大多数比较均未发现统计学上的显著差异，无法得出明确结论。然而，一些试验比较了两种常用的内固定策略，即伽马钉（GN）和动力髋螺钉（SHS）。有充分证据表明，与SHS相比，GN可能会增加穿出风险（OR = 1.87，95%CI，1.08至3.21）、再次手术风险（OR = 1.61，95%CI，1.02至2.53）、术中骨折风险（OR = 3.14，95%CI，1.34至7.35）和后期骨折风险（OR = 3.67，95%CI，1.37至9.83）。有必要开展精心设计和实施的未来随机试验或观察性研究，以确定股骨转子间骨折替代内固定策略的效果。
