Mei Xin Y, Gong Ying Jia, Safir Oleg A, Gross Allan E, Kuzyk Paul R
Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
JBJS Rev. 2018 Jun;6(6):e4. doi: 10.2106/JBJS.RVW.17.00164.
The optimal system for greater trochanteric fixation following osteotomy or fracture remains unknown. This systematic review aims to synthesize the available English-language literature on 5 commonly reported trochanteric fixation methods to quantify and compare rates of complications and reoperation.
A comprehensive search of MEDLINE and Embase databases from January 1946 to June 2017 was performed for articles in English describing fixation of trochanteric osteotomies and fractures using wires, cables, cable-plate devices, claw or locking plates, and trochanteric bolts. Pooled mean rates of complications and reoperation with 95% confidence intervals (CIs) were analyzed using a random-effects model.
Fifty-seven studies involving 10,956 hips were eligible for inclusion. Five studies had Level-III evidence and 52 had Level-IV evidence. The pooled mean rate of nonunion was 4.17% (95% CI, 3.21% to 5.13%; I = 79%) for wires, 5.07% (95% CI, 0.37% to 9.77%; I = 74%) for cables, 16.11% (95% CI, 10.85% to 21.37%; I = 89%) for cable-plate systems, 9.60% (95% CI, 2.23% to 16.97%; I = 59%) for claw or locking plates, and 12.42% (95% CI, 3.41% to 21.43%; I = 75%) for trochanteric bolts. Substantial heterogeneity in the data precluded formal statistical comparison of outcomes and complications between implants.
Available literature on the various trochanteric fixation implants is heterogeneous and consists primarily of retrospective case series. Based on the current literature, it is difficult to support the use of one implant over another. Despite superior mechanical properties, rates of complication and reoperation following cable-plate fixation remains suboptimal, especially in complex revision scenarios. Additional rigorous prospective randomized and cohort studies are needed to make definitive recommendations regarding the most reliable method of trochanteric fixation.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
截骨术或骨折后大转子固定的最佳系统尚不清楚。本系统评价旨在综合现有的英文文献，这些文献涉及5种常见的大转子固定方法，以量化和比较并发症发生率及再次手术率。
对1946年1月至2017年6月的MEDLINE和Embase数据库进行全面检索，查找用英文撰写的描述使用钢丝、缆线、缆线钢板装置、爪形或锁定钢板以及大转子螺栓固定大转子截骨术和骨折的文章。采用随机效应模型分析并发症和再次手术的合并平均发生率及95%置信区间（CI）。
57项研究涉及10956例髋关节，符合纳入标准。5项研究有III级证据，52项有IV级证据。钢丝固定不愈合的合并平均发生率为4.17%（95%CI，3.21%至5.13%；I² = 79%），缆线为5.07%（95%CI，0.37%至9.77%；I² = 74%），缆线钢板系统为16.11%（95%CI，10.85%至21.37%；I² = 89%），爪形或锁定钢板为9.60%（95%CI，2.23%至16.97%；I² = 59%），大转子螺栓为12.42%（95%CI，3.41%至21.43%；I² = 75%）。数据中的显著异质性使得无法对不同植入物的结局和并发症进行正式的统计学比较。
关于各种大转子固定植入物的现有文献具有异质性，主要由回顾性病例系列组成。基于当前文献，很难支持使用一种植入物优于另一种。尽管缆线钢板固定具有优越的力学性能，但其并发症和再次手术率仍不理想，尤其是在复杂的翻修情况下。需要更多严格的前瞻性随机和队列研究，以就最可靠的大转子固定方法给出明确建议。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
