Harvard Orthopaedic Trauma Initative, 1811Harvard Medical School, Boston, Massachusetts, USA.
Department of Orthopaedics and Trauma Surgery, 27271Medical University of Vienna, Waehringer Guertel 18-20,1090, Vienna, Austria.
J Orthop Surg (Hong Kong). 2021 Jan-Apr;29(1):23094990211003344. doi: 10.1177/23094990211003344.
This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures.
A comprehensive search of databases, including MEDLINE, Embase, Web of Science, and Cochrane Central for studies published in English on or before June 21, 2019 was performed. Selected search terms included "basicervical," "basi cervical," "AO/OTA type 31-B," "femoral neck fracture" AND "bone nails," "bone screws," "fracture fixation," "internal fixation," "arthroplasty," "cephalomedullary," "sliding hip screw," "ORIF," and "treatment outcome." We included studies that assessed outcomes of basicervical fracture fixation using open reduction internal fixation or arthroplasty. Two authors extracted the following data from each paper: study design, country, cohort year, definition of basicervical, intervention type, sample size, patient demographics, follow-up length, percent of fractures that required revision, and the percent of implants that failed.
Sixteen articles encompassing 910 patients were included. The main outcome was the percent of implants that required revision. The total revision rates were 8% (8 studies, 157 patients, range 0%-55%) for cephalomedullary nails, 7% (10 studies, 584 patients, range 0%-18%) for sliding hip screws, 23% (3 studies, 40 patients, range 16%-50%) for cannulated screws, 0% (1 study, 6 patients) for total hip arthroplasty, and 8% (2 studies, 13 patients, range 0%-11%) for hemiarthroplasty.
Management of basicervical fractures with SHS and CMN produces similar failure and re-operation rates. Limited evidence is available on the use of cannulated screws and arthroplasty, but available studies suggest that cannulated screws have an unacceptable revision rate (23%) while arthroplasty may be acceptable. Future studies examining the comparative efficacy of various fixation methods would benefit from strict definition of fracture type as well as consistent reporting of functional outcomes, re-operation rates, and mortality.
本研究旨在系统回顾比较基础颈型髋部骨折的手术治疗选择及各自失败率的文献。
对 MEDLINE、Embase、Web of Science 和 Cochrane 中央数据库进行全面检索，检索时间截至 2019 年 6 月 21 日，纳入研究为发表在英文期刊上的基础颈型骨折的治疗方法选择及各自失败率的比较研究。检索词包括“基础颈型”“AO/OTA 31-B 型”“股骨颈骨折”和“骨钉”“骨螺钉”“骨折固定”“内固定”“关节成形术”“股骨颈骨”“滑动髋螺钉”“切开复位内固定”和“治疗结果”。我们纳入了使用切开复位内固定或关节成形术评估基础颈型骨折固定效果的研究。两位作者从每篇论文中提取以下数据：研究设计、国家、队列年份、基础颈型的定义、干预类型、样本量、患者人口统计学特征、随访时间、需要翻修的骨折百分比以及失败的植入物百分比。
共纳入 16 篇文献，涵盖 910 例患者。主要结局是需要翻修的植入物百分比。总的翻修率为：股骨颈骨钉 8%（8 项研究，157 例患者，范围 0%-55%）；滑动髋螺钉 7%（10 项研究，584 例患者，范围 0%-18%）；空心螺钉 23%（3 项研究，40 例患者，范围 16%-50%）；全髋关节置换术 0%（1 项研究，6 例患者）；半髋关节置换术 8%（2 项研究，13 例患者，范围 0%-11%）。
使用滑动髋螺钉和股骨颈骨钉治疗基础颈型骨折的失败率和再手术率相似。使用空心螺钉和关节成形术的证据有限，但现有研究表明，空心螺钉的翻修率（23%）不可接受，而关节成形术可能是可接受的。未来研究在比较各种固定方法的疗效时，应严格定义骨折类型，并一致报告功能结果、再手术率和死亡率。
