Zhang Yaqiang, Xue Yun, Zhao Maosheng, Chen Xianxia, Gao Qiuming
Department of Orthopedics, The 940th Hosptial of Joint Logistics Support Force of Chinese People's Liberation Army, Gansu, China.
Lanzhou University Second Hospital, Gansu, China.
Front Pediatr. 2023 Mar 3;11:1114265. doi: 10.3389/fped.2023.1114265. eCollection 2023.
Titanium elastic nails (TENs) and locking plates (LPs) are currently the main internal fixation for treating pediatric subtrochanteric femur fractures, and the optimal choice of internal fixation is controversial. This study aimed to systematically evaluate the effectiveness and safety of TENs and LPs in treating subtrochanteric fractures in children to provide a theoretical basis and reference for clinical treatment.
The literature related to TENs and LPs for treating subtrochanteric fractures in children was searched using the CNKI, PubMed, Cochrane, Embase, and Web of Science, and the search time frame was from the establishment of the database to October 2022. Two evaluators screened the literature according to the inclusion and exclusion criteria and extracted relevant data. Meta-analysis was performed using Stata14.0 software.
A total of 9 studies with 407 patients with subtrochanteric femur fractures were included in the final screening, including 210 cases with TENs and 197 cases with LPs. Meta-analysis results showed that compared with the locking plate, TEN had a shorter operative time [WMD = -1.3, 95%CI(-1.94,-0.66), < 0.01], less intraoperative bleeding [WMD = -84.45, 95%CI(-111.09, -57.82), < 0.01], shorter fracture healing time [WMD = -1.3, 95%CI(-1.94,-0.66), < 0.01], shorter hospital stays [WMD = -2.80, 95% CI(-4.63,-0.98), < 0.01], and earlier full weight bearing [SMD = -0.48, 95% CI(-0.91,-0.04), < 0.05] but more intraoperative fluoroscopy [WMD = 28.23, 95% CI(15.22,41.25), < 0.05]. The overall complication rate was high [OR = 3.52, 95% CI(1.96,6.34), < 0.05], and the postoperative period was prone to angulation, rotation, and inversion deformity [OR = 3.68, 95% CI(1.40, 9.68), < 0.05]. No significant difference in the incidence of lower limb inequality between the two types of internal fixation [OR = 0.83, 95% CI(0.38, 1.85), > 0.05] and no significant difference in the Harris score of the hip at the last follow-up between the two types of internal fixation [WMD = -0.67, 95% CI(-2.01,0.67), > 0.05] were found.
In comparison to LPs, TENs have a shorter operation time, less intraoperative bleeding, and a shorter fracture healing time, and the child can be fully weight-bearing earlier. Locking plates can reduce the operator's x-ray exposure, and the incidence rate of postoperative angulation, rotation, and inversion deformity is low. Therefore, TENs and LPs are the best internal fixation methods for treating subtrochanteric fractures in children.
钛弹性髓内钉（TENs）和锁定钢板（LPs）是目前治疗小儿股骨转子下骨折的主要内固定方式，内固定的最佳选择存在争议。本研究旨在系统评价TENs和LPs治疗儿童股骨转子下骨折的有效性和安全性，为临床治疗提供理论依据和参考。
通过中国知网、PubMed、Cochrane、Embase及Web of Science检索与TENs和LPs治疗儿童股骨转子下骨折相关的文献，检索时间范围为各数据库建库至2022年10月。两名评价者根据纳入和排除标准筛选文献并提取相关数据。采用Stata14.0软件进行Meta分析。
最终筛选出9项研究，共407例股骨转子下骨折患儿，其中TENs组210例，LPs组197例。Meta分析结果显示，与锁定钢板相比，TEN手术时间更短[加权均数差（WMD）=-1.3，95%可信区间（CI）（-1.94，-0.66），P<0.01]，术中出血量更少[WMD=-84.45，95%CI（-111.09，-57.82），P<0.01]，骨折愈合时间更短[WMD=-1.3，95%CI（-1.94，-0.66），P<0.01]，住院时间更短[WMD=-2.80，95%CI（-4.63，-0.98），P<0.01]，完全负重时间更早[标准化均数差（SMD）=-0.48，95%CI（-0.91，-0.04），P<0.05]，但术中透视次数更多[WMD=28.23，95%CI（15.22，41.25），P<0.05]。总体并发症发生率较高[比值比（OR）=3.52，95%CI（1.96，6.34），P<0.05]，术后易出现成角、旋转及内翻畸形[OR=3.68，95%CI（1.40，9.68），P<0.05]。两种内固定方式在下肢不等长发生率上差异无统计学意义[OR=0.83，95%CI（0.38，1.85），P>0.05]，末次随访时髋关节Harris评分差异也无统计学意义[WMD=-0.67，95%CI（-2.01，0.67），P>0.05]。
与LPs相比，TENs手术时间短、术中出血少、骨折愈合时间短，患儿可更早完全负重。锁定钢板可减少术者X线暴露，术后成角、旋转及内翻畸形发生率低。因此，TENs和LPs都是治疗儿童股骨转子下骨折的最佳内固定方法。
