短与长股骨近端髓内钉治疗股骨转子间骨折：3208 例患者的荟萃分析。
Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients.
机构信息
Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA.
Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA.
出版信息
Arch Orthop Trauma Surg. 2022 Jul;142(7):1367-1374. doi: 10.1007/s00402-021-03752-z. Epub 2021 Jan 23.
OBJECTIVES
The purpose of the study was to compare treatment outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures.
DATA SOURCES
A systematic review of perioperative outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures was performed. The following databases were used: using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019). The queries were performed in June 2019.
STUDY SELECTION
The following search term query was used: "Intramedullary Nail AND Intertrochanteric Fracture OR "Long OR Short Nail AND intertrochanteric Fracture." Studies were excluded if they were "single-arm" studies (i.e., reporting on either long or short CMN but not both), or did not report at least one of the outcomes being meta-analyzed. Furthermore, cadaveric studies, animal studies, basic science articles, editorial articles, surveys and studies were excluded.
DATA EXTRACTION
Two investigators independently reviewed abstracts from all identified articles. Full-text articles were obtained for review if necessary, to allow further assessment of inclusion and exclusion criteria. Additionally, all references from the included studies were reviewed and reconciled to verify that no relevant articles were missing from the systematic review.
DATA SYNTHESIS
Short nails were associated with statistically significantly less estimated blood loss and operative time compared to long nails. There were no significant differences in transfusion rates, implant failures or overall re-operation rates between implant lengths. Similarly, there was no significant difference in peri-implant fracture between implant lengths.
CONCLUSIONS
Overall, the available clinical evidence supports the use of short cephalomedullary nails for the majority of intertrochanteric femur fractures.
STUDY DESIGN/LEVEL OF EVIDENCE: Meta-analysis; Level III, therapeutic.
目的
本研究旨在比较股骨转子间骨折短、长髓内钉治疗的效果。
资料来源
对股骨转子间骨折短、长髓内钉治疗的围手术期结果进行了系统评价。使用了以下数据库：Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、PubMed（1980-2019 年）和 MEDLINE（1980-2019 年）。查询于 2019 年 6 月进行。
研究选择
使用了以下搜索词查询：“髓内钉和转子间骨折或长或短钉和转子间骨折”。如果研究是“单臂”研究（即报告长或短 CMN 但不是两者），或者没有报告正在进行荟萃分析的至少一个结果，则将其排除在外。此外，还排除了尸体研究、动物研究、基础科学文章、社论文章、调查和研究。
资料提取
两名调查员独立审查了所有已识别文章的摘要。如果有必要，获取全文文章以进行进一步评估纳入和排除标准。此外，还审查了纳入研究的所有参考文献，并进行了核对，以确保系统评价中没有遗漏相关文章。
资料综合
与长髓内钉相比，短髓内钉与明显较少的估计失血量和手术时间相关。在输血率、植入物失败或总体再手术率方面，植入物长度之间没有显著差异。同样，在植入物长度之间，围植入物骨折也没有显著差异。
结论
总的来说，现有的临床证据支持在大多数转子间骨折中使用短髓内钉。
研究设计/证据水平：荟萃分析；III 级，治疗性。
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