Saad Ahmed, Patralekh Mohit Kumar, Jain Vijay Kumar, Shrestha Sagaurav, Botchu Rajesh, Iyengar Karthikeyan P
Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB, UK.
Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India.
J Clin Orthop Trauma. 2022 Jun 11;30:101917. doi: 10.1016/j.jcot.2022.101917. eCollection 2022 Jul.
Femoral neck fractures (FNF) in adults are conventionally managed with surgical options. This paper is aimed to assess the safety, and functional outcomes of the novel Femoral neck system (FNS) for FNF treatment in adult population.
An organized quest of four literature databases (PubMed, Scopus, Web of Science, and Cochrane Library) was performed on March 1, 2022 using the term "femoral neck system". Fixed or random-effect meta-analysis was used to analyse the outcome measures after selecting relevant studies and assessing their quality. Heterogeneity was considered when calculating pooled effect sizes and 95% confidence ranges.
On comparing FNS with cannulated cancellous screws (CCS) or other methods, in a total of 762 patients (351 FNS and 411 CCS) in the 11 comparative studies considered for meta-analysis, blood loss was pointedly higher overall in the FNS group, mean difference 115.77 ml; 95% CI 3.11 ml, 28.42 ml; test of overall effect: z = 1.68, p = 0.09); with considerable heterogeneity. However, in the FNS group the operative time was substantially lower (Mean difference -7.91 min; 95% CI -15.01, -0.80; test of overall effect: z = 2.18, p = 0.03, with marked heterogeneity). Moreover, complications such as infections, non-union, osteonecrosis, implant cut-out were significantly lower in the FNS group with a Mantel Haenszel Odds ratio of 0.20 (95% CI 0.12, 0.34: Z = 6.01, p < 0.0001).
Keeping in mind the heterogenicity of the studies, -management of adult patients with FNF with FNS can provide results comparable to traditional fixation methods with significantly lower rate of complications.
成人股骨颈骨折（FNF）传统上采用手术方法治疗。本文旨在评估新型股骨颈系统（FNS）治疗成人FNF的安全性和功能结果。
2022年3月1日，使用“股骨颈系统”一词对四个文献数据库（PubMed、Scopus、科学网和考克兰图书馆）进行了系统检索。在选择相关研究并评估其质量后，采用固定效应或随机效应荟萃分析来分析结果指标。计算合并效应量和95%置信区间时考虑了异质性。
在纳入荟萃分析的11项比较研究中的总共762例患者（351例FNS和411例空心松质骨螺钉[CCS]）中，将FNS与CCS或其他方法进行比较时，FNS组的总体失血量明显更高，平均差异为115.77毫升；95%置信区间为3.11毫升，28.42毫升；总体效应检验：z = 1.68，p = 0.09）；存在相当大的异质性。然而，FNS组的手术时间明显更短（平均差异-7.91分钟；95%置信区间为-15.01，-0.80；总体效应检验：z = 2.18，p = 0.03，存在明显异质性）。此外，FNS组的感染、骨不连、骨坏死、植入物穿出等并发症明显更低，Mantel Haenszel优势比为0.20（95%置信区间为0.12，0.34：Z = 6.01，p < 0.0001）。
考虑到研究的异质性，使用FNS治疗成人FNF患者可提供与传统固定方法相当的结果，且并发症发生率显著更低。
