Department of Orthopaedics, Peterborough City Hospital, Peterborough PE3 9GZ, United Kingdom.
Department of Orthopaedic Surgery, Haukeland University Hospital, Department of Surgical Sciences, University of Bergen, Bergen, Norway.
Injury. 2018 Jul;49(7):1319-1323. doi: 10.1016/j.injury.2018.05.017. Epub 2018 May 22.
Continuing controversy exists for the choice of implant for treating A3 trochanteric hip fractures so we undertook a systematic review of randomised controlled trials from the year 2000 onwards that have compared an intramedullary nail with an extramedullary fixation implant for the treatment of these fractures. Data on the occurrence of any fracture healing complications was extracted and the results combined to calculate Peto odd ratio. Nine studies involving 370 fractures were identified. Three studies involving 105 fractures compared an intramedullary nail with a static fixation (condylar, blade or locking plate). Plate fixation was associated with a fivefold increase risk of fracture healing complications (19/52(36.6%) versus 4/53(7.5%), odds ratio 0.14, 95% Confidence intervals 0.04-0.45). Six studies involving 265 fractures compared an intramedullary nail with a sliding hip screw. No statistically significant difference was found in the occurrence of facture healing complications between implants (13/137(9.5%) versus 11/128(8.6%) odds ratio 0.28, 95% Confidence intervals 0.50-2.80). Bases on the evidence to date from randomised trials, the use of fixed nail plates for surgical fixation of this type of fracture cannot be justified. Intramedullary nail fixation and the sliding hip screw have comparable fracture healing complication rates.
对于治疗 A3 转子间髋部骨折的植入物选择，仍存在持续争议，因此我们对 2000 年以来的随机对照试验进行了系统评价，这些试验比较了髓内钉与髓外固定植入物治疗这些骨折的效果。提取了任何骨折愈合并发症发生的数据，并将结果合并计算了 Peto 比值比。确定了 9 项涉及 370 例骨折的研究。其中 3 项涉及 105 例骨折的研究比较了髓内钉与静态固定（髁、刀片或锁定板）。钢板固定与骨折愈合并发症的五倍风险相关（19/52(36.6%) 比 4/53(7.5%)，比值比 0.14，95%置信区间 0.04-0.45）。涉及 265 例骨折的 6 项研究比较了髓内钉与滑动髋螺钉。两种植入物的骨折愈合并发症发生率无统计学差异（13/137(9.5%) 比 11/128(8.6%)，比值比 0.28，95%置信区间 0.50-2.80）。基于目前随机试验的证据，不能为这种骨折的手术固定使用固定钉板提供依据。髓内钉固定和滑动髋螺钉具有相似的骨折愈合并发症发生率。
