Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin 9, Ireland.
Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Ir J Med Sci. 2020 Nov;189(4):1317-1322. doi: 10.1007/s11845-020-02184-9. Epub 2020 Feb 18.
The dynamic hip screw (DHS) is a common device used in the fixation of hip fractures. Traditionally, this involves the use of a four-hole side plate. Reducing the length of the side plate would theoretically reduce the amount of surgical exposure required, decrease surgery duration, and decrease perioperative morbidity and mortality. Our study aims to review the current evidence regarding the use of two-hole side plates, their use and potential complications.
Using PRISMA guidelines, two independent reviewers performed a search to collate the available literature from medical databases PubMed, EMBASE, Web of Science, and the Cochrane library. Only clinical and biochemical studies were included. The reference lists of articles included for full text review were searched for any additional primary or review publications.
Four online libraries were searched, with a combined total of 5344 titles reviewed. Following title, abstract, and full text review, 8 articles were considered suitable for inclusion in qualitative analysis. There was a trend towards equal efficiency between two- and four-hole plates when used in stable fractures in terms of blood loss, failure/revision rates, operative and hospital stay durations, collapse loading testing, maximum stress, and fragment migration.
The results of this study show that DHS constructs with two- or four-hole side plates have comparable outcomes when used in patients with stable fracture patterns. However, the majority of the clinical data regarding the use of two-hole DHS plates come from retrospective case series; further prospective, randomised control trials would be of significant benefit.
Level II; systematic review of all levels of evidence.
动力髋螺钉（DHS）是一种常用于固定髋部骨折的常见装置。传统上，这涉及使用四孔侧钢板。理论上，缩短侧钢板的长度可以减少所需的手术暴露量，缩短手术时间，并降低围手术期发病率和死亡率。我们的研究旨在回顾使用两孔侧钢板的现有证据，及其使用和潜在并发症。
使用 PRISMA 指南，两名独立的审查员进行了搜索，以汇集来自 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆等医学数据库的可用文献。仅包括临床和生化研究。对纳入全文审查的文章的参考文献列表进行了搜索，以查找任何其他原发性或综述出版物。
共搜索了四个在线数据库，总共审查了 5344 个标题。经过标题、摘要和全文审查，有 8 篇文章被认为适合定性分析。在稳定骨折中，使用两孔和四孔钢板时，在失血量、失败/翻修率、手术和住院时间、塌陷负荷测试、最大应力和碎片迁移方面，两者的效率趋势相当。
这项研究的结果表明，在稳定骨折模式的患者中，使用 DHS 带有两孔或四孔侧钢板的构建体具有可比的结果。然而，关于两孔 DHS 钢板使用的大多数临床数据来自回顾性病例系列；进一步的前瞻性、随机对照试验将具有重要意义。
二级；所有证据水平的系统评价。
