Wu Zhi-Fang, Luo Zi-Heng, Hu Liu-Chao, Luo Yi-Wen
Department of Orthopedics and Trauma, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine), Guangzhou 510378, Guangdong Province, China.
World J Clin Cases. 2022 Nov 6;10(31):11454-11465. doi: 10.12998/wjcc.v10.i31.11454.
Controversy remains around the available choices for the internal fixation of a femoral neck fracture. The femoral neck system (FNS) was developed in 2018 and has been widely applied since then as it can provide rigid fixation stability with less damage to the bone mass around the fracture. However, no systematic reviews and meta-analyses have investigated the efficacy of the FNS in comparison with that of traditional internal fixation in the treatment of femoral fractures.
To assess the efficacy of the FNS in comparison with that of cannulated compression screws (CCS) in the treatment of femoral fractures through systematic review and meta-analysis.
Five electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang) were searched from the earliest publication date to December 31, 2021. Reference Citation Analysis (https://www.referencecitationanalysis.com/) was used to check the results and further analyze the related articles. Controlled trials were included if the FNS was applied for the femoral neck fracture in adults and if it was compared with CCS for the achievement of internal fixation. The measurement outcomes included the required operation time, observed patient's blood loss, extent of fracture healing, patient's Harris Hip score (HHS) at the last follow-up, and records of any complications (such as failure of internal fixation, femoral neck shortness, avascular necrosis of the femoral head, and delayed union or nonunion).
Ten retrospective controlled studies (involving 711 participants) were included in this meta-analysis. The meta-analysis showed that compared with CCS, use of the FNS could not decrease the operation time [standardized mean difference (SMD): -0.38, 95% confidence interval (CI): -0.98 to 0.22, = 0.21, = 93%), but it could increase the intraoperative blood loss (SMD: 0.59, 95%CI: 0.15 to 1.03, = 0.009, = 81%). The pooled results also showed that compared with CCS, the FNS could better promote fracture healing (SMD: -0.97, 95%CI: -1.65 to -0.30, = 0.005, = 91%), improve the HHS at the last follow-up (SMD: 0.76, 95%CI: 0.31 to 1.21, = 0.0009, = 84%), and reduce the chances of developing femoral neck shortness (OR: 0.29, 95%CI: 0.14 to 0.61, = 0.001, = 0%) and delayed union or nonunion (OR: 0.47, 95%CI: 0.30 to 0.73, = 0.001; = 0%) in adult patients with femoral neck fractures. However, there was no statistically significant difference between the FNS and CCS in terms of failure of internal fixation (OR: 0.49, 95%CI: 0.23 to 1.06, = 0.07, = 0%) and avascular necrosis of the femoral head (OR: 0.46, 95%CI: 0.20 to 1.10, = 0.08, = 0%).
Compared with CCS, the FNS could decrease the chances of developing femoral neck shortness and delayed union or nonunion in adults with femoral neck fractures. Simultaneously, it could accelerate fracture healing and improve the HHS in these patients.
股骨颈骨折内固定的可用选择仍存在争议。股骨颈系统（FNS）于2018年研发，自那时起已被广泛应用，因为它能提供牢固的固定稳定性，同时对骨折周围骨量的损伤较小。然而，尚无系统评价和荟萃分析研究FNS与传统内固定相比在治疗股骨骨折方面的疗效。
通过系统评价和荟萃分析评估FNS与空心加压螺钉（CCS）相比在治疗股骨骨折方面的疗效。
检索了五个电子数据库（PubMed、Embase、Cochrane对照试验中央注册库、中国知网和万方），检索时间从最早发表日期至2021年12月31日。使用参考文献引用分析（https://www.referencecitationanalysis.com/）检查结果并进一步分析相关文章。纳入的对照试验需满足将FNS应用于成人股骨颈骨折，且与CCS比较以实现内固定。测量指标包括所需手术时间、观察到的患者失血量、骨折愈合程度、末次随访时患者的Harris髋关节评分（HHS）以及任何并发症的记录（如内固定失败、股骨颈缩短、股骨头缺血性坏死以及延迟愈合或不愈合）。
本荟萃分析纳入了10项回顾性对照研究（涉及711名参与者）。荟萃分析表明，与CCS相比，使用FNS不能缩短手术时间[标准化均数差（SMD）：-0.38，95%置信区间（CI）：-0.98至0.22，P = 0.21，I² = 93%]，但会增加术中失血量（SMD：0.59，95%CI：0.15至1.03，P = 0.009，I² = 81%）。汇总结果还显示，与CCS相比，FNS能更好地促进骨折愈合（SMD：-0.97，95%CI：-1.65至-0.30，P = 0.005，I² = 91%），提高末次随访时的HHS（SMD：0.76，95%CI：0.31至1.21，P = 0.0009，I² = 84%），并降低成人股骨颈骨折患者发生股骨颈缩短（比值比：0.29，95%CI：0.14至0.61，P = 0.001，I² = 0%）和延迟愈合或不愈合（比值比：0.47，95%CI：0.30至0.73，P = 0.001；I² = 0%）的几率。然而，FNS与CCS在内固定失败（比值比：0.49，95%CI：0.23至1.06，P = 0.07，I² = 0%）和股骨头缺血性坏死（比值比：0.46，95%CI：0.20至1.10，P = 0.08，I² = 0%）方面无统计学显著差异。
与CCS相比，FNS可降低成人股骨颈骨折患者发生股骨颈缩短和延迟愈合或不愈合的几率。同时，它可加速这些患者的骨折愈合并提高HHS。
