Department of Orthopedics, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Department of Orthopedics, People's Hospital of Tongchuan, Tongchuan, China.
Orthop Surg. 2020 Apr;12(2):639-644. doi: 10.1111/os.12629. Epub 2020 Mar 11.
To comprehensively assess the differences in outcome between open reduction and closed reduction for children and adolescents with femoral neck fractures.
Based on the predetermined strategies, eligible studies were obtained by searching Embase, the Cochrane Library, and PubMed databases (retrieval time: June 2018) and through manual retrieval for paper documents. The 95% confidence intervals (CI) and risk ratios (RR) were used as evaluation indexes. Moreover, the results of avascular necrosis, coxa vara, or non-union were compared between open reduction and closed reduction under random or fixed effects models. After sensitivity analysis was carried out, publication bias was evaluated for the eligible studies using Egger's test.
Six studies were included in our meta-analysis. No significant heterogeneity was found among the included studies (P ≥ 0.05) and, thus, the fixed effects model was used for merging the effect sizes of avascular necrosis (RR [95% CI] = 0.50 [0.26, 0.98], P = 0.04), coxa vara (RR [95% CI] = 0.16 [0.04, 0.70], P = 0.01), and non-union (RR [95% CI] = 0.22 [0.05, 0.93], P = 0.04). Sensitivity analysis suggested that the results of avascular necrosis were not stable (RR = 0.50, 95% CI = 0.25 1.17, P = 0.12), while those of coxa vara and non-union were stable. There was no significant publication bias among the eligible studies (t = -0.70, P = 0.522).
Femoral neck fractures treated by open reduction had less adverse outcomes compared with those treated by closed reduction.
全面评估儿童和青少年股骨颈骨折切开复位与闭合复位治疗效果的差异。
根据预先制定的策略，通过检索 Embase、Cochrane 图书馆和 PubMed 数据库（检索时间：2018 年 6 月）以及手动检索纸质文献，获取符合条件的研究。95%置信区间（CI）和风险比（RR）被用作评估指标。此外，还在随机或固定效应模型下比较了切开复位与闭合复位治疗后发生股骨头坏死、髋内翻或骨不连的结果。对符合条件的研究进行敏感性分析后，采用 Egger 检验评估发表偏倚。
本荟萃分析纳入 6 项研究。纳入研究之间无显著异质性（P≥0.05），因此采用固定效应模型合并股骨头坏死（RR [95% CI] = 0.50 [0.26, 0.98]，P = 0.04）、髋内翻（RR [95% CI] = 0.16 [0.04, 0.70]，P = 0.01）和骨不连（RR [95% CI] = 0.22 [0.05, 0.93]，P = 0.04）的效应大小。敏感性分析提示股骨头坏死的结果不稳定（RR = 0.50，95% CI = 0.25~1.17，P = 0.12），而髋内翻和骨不连的结果稳定。纳入的研究均无显著发表偏倚（t = -0.70，P = 0.522）。
与闭合复位相比，切开复位治疗儿童和青少年股骨颈骨折的不良结局更少。
