髓内与髓外固定治疗转子下骨折：系统评价与荟萃分析。
Intramedullary versus extramedullary fixation for the treatment of subtrochanteric fracture: A systematic review and meta-analysis.
机构信息
Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzho, 325000, China.
Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzho, 325000, China.
出版信息
Int J Surg. 2019 Mar;63:43-57. doi: 10.1016/j.ijsu.2019.01.021. Epub 2019 Feb 6.
PURPOSE
This meta-analysis was performed to investigate the outcomes of intramedullary fixation versus extramedullary fixation in the treatment of subtrochanteric fracture from the current literature.
METHODS
The electronic literature database of PubMed, Embase, Cochrane library, CNKI and Wanfang were searched in December 2018. The data operation time, intraoperative blood loss, length of incision, length of stay, union time, rate of infection, rate of fixation failure, rate of refracture, rate of reoperation, rate of nonunion and rate of excellent and good results were extracted. Stata 14.0 software was used for our meta-analysis.
RESULTS
A total of 11 studies including 8 RCTs and 3 cohort studies met our inclusion criteria. This meta-analysis showed that intramedullary fixation could achieve significantly shorter operation time (P = 0.000), less intraoperative blood loss (P = 0.000), shorter length of incision (P = 0.000) and length of stay (P = 0.001) with evidently lower rate of fixation failure (P = 0.001), rate of reoperation (P = 0.003) and higher rate of excellent and good functional results (P = 0.003) than extramedullary fixation for subtrochanteric fractures. However, no significant difference was found regarding union time (P = 0.17), rate of infection (P = 0.99), rate of refracture (P = 0.98) and rate of nonunion (P = 0.42) between the two groups.
CONCLUSION
Our meta-analysis suggested that intramedullary fixation for subtrochanteric fracture might be superior to extramedullary fixation in term of shorter operation time, less intraoperative blood loss, shorter length of incision, length of stay and better functional outcomes. Meanwhile, intramedullary fixation had lower rate of fixation failure and reoperation. Therefore, we recommend intramedullary fixation as the treatment of subtrochanteric fracture. More large multi-center and high-quality RCTs are required for further research.
目的
本荟萃分析旨在从现有文献中研究髓内固定与髓外固定治疗转子下骨折的疗效。
方法
检索 2018 年 12 月 PubMed、Embase、Cochrane 图书馆、CNKI 和万方的电子文献数据库。提取数据操作时间、术中失血量、切口长度、住院时间、愈合时间、感染率、固定失败率、再骨折率、再手术率、非愈合率和优良结果率。使用 Stata 14.0 软件进行荟萃分析。
结果
共纳入 11 项研究，其中 8 项 RCT 和 3 项队列研究符合纳入标准。荟萃分析显示，髓内固定在手术时间（P=0.000）、术中失血量（P=0.000）、切口长度（P=0.000）和住院时间（P=0.001）更短，固定失败率（P=0.001）、再手术率（P=0.003）更低，优良功能结果率（P=0.003）更高，而转子下骨折的愈合时间（P=0.17）、感染率（P=0.99）、再骨折率（P=0.98）和非愈合率（P=0.42）差异无统计学意义。
结论
本荟萃分析表明，髓内固定治疗转子下骨折在手术时间、术中失血量、切口长度、住院时间和功能结果方面优于髓外固定。同时，髓内固定固定失败和再手术率较低。因此，我们推荐髓内固定作为转子下骨折的治疗方法。需要更多大样本、多中心、高质量的 RCT 进一步研究。
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