Soni Aditya, Munshi Sandeep, Radhamony Niranj G, Nair Rajiv, Sreenivasan Sachith
Trauma and Orthopaedics, Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow-in-Furness, GBR.
Trauma and Orthopaedics, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR.
Cureus. 2022 Mar 14;14(3):e23138. doi: 10.7759/cureus.23138. eCollection 2022 Mar.
There has always been a debate between the use of four and two-hole plate for the fixation of stable intertrochanteric fractures. The choice is usually influenced by the general practice of the particular institution and the surgeon's preference. While the dynamic hip screw (DHS) is the implant of choice for stable intertrochanteric fractures of the femur, the length of the side plate to be chosen for optimal results has no clear consensus and previous studies regarding the same have been inconclusive. In our systematic review, we aimed to review the evidence available on the selection of the optimal length of the side plate and bridge the glaring gap that exists in the literature. Our systematic review included a thorough search of databases like PubMed, Embase, MEDLINE, CINAHL, and the Cochrane Library, using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included both clinical and biomechanical studies satisfying our search criteria on two- and four-hole DHS implants. A total of 4556 results were obtained from the above databases, sorting out led to final 15 studies on the topic. It was found that the two-hole DHS implant was inferior in terms of lab-controlled biomechanical properties, while only having a slight advantage in terms of real-life postoperative blood transfusions and operative time. At the same time, the two-hole plate was similar to the four-hole plate in other clinical parameters. In this study, the two-hole plate while appearing promising in a few areas did fall short in other aspects like biomechanical studies, and the use should be reserved for cases where a four-hole plate cannot be used until further randomised control trials are carried out.
在使用四孔和两孔钢板固定稳定型股骨转子间骨折方面，一直存在着争议。这种选择通常受特定机构的常规做法和外科医生偏好的影响。虽然动力髋螺钉（DHS）是治疗股骨稳定型转子间骨折的首选植入物，但对于选择何种长度的侧板可获得最佳效果，目前尚无明确的共识，以往关于这方面的研究也尚无定论。在我们的系统评价中，我们旨在回顾关于选择侧板最佳长度的现有证据，并弥合文献中存在的明显差距。我们的系统评价包括使用系统评价和Meta分析的首选报告（PRISMA）指南，对PubMed、Embase、MEDLINE、CINAHL和Cochrane图书馆等数据库进行全面检索。我们纳入了符合我们检索标准的关于两孔和四孔DHS植入物的临床和生物力学研究。从上述数据库共获得4556条结果，筛选后最终得到15项关于该主题的研究。结果发现，两孔DHS植入物在实验室控制的生物力学性能方面较差，而在实际术后输血和手术时间方面仅略有优势。同时，两孔钢板在其他临床参数方面与四孔钢板相似。在本研究中，两孔钢板虽然在一些方面看起来很有前景，但在生物力学研究等其他方面确实存在不足，在进行进一步的随机对照试验之前，其使用应仅限于无法使用四孔钢板的病例。
