College of Management, Guangdong Polytechnic Normal University, Guangzhou, China.
Department of Orthopedics, Huaiji People's Hospital, Zhaoqing, China.
BMC Musculoskelet Disord. 2023 Jul 18;24(1):588. doi: 10.1186/s12891-023-06715-0.
Hip fractures are still unsolved problems nowadays. We evaluated the functional outcomes and complications in the treatment of hip fractures (AO/OTA31A1-A3) to find potential difference and risk between intramedullary nail (IMN) and dynamic hip screw (DHS).
We searched PubMed, Embase, Cochrane library up to 19 June 2023 and retrieved any studies comparing IMN and DHS in treatment of Hip fractures. The main outcomes and complications were extracted from the included studies. The fixed-effect model was selected to pool the data for homogeneous studies (I < 50%). Otherwise, the random effects model was selected (heterogeneity, I > 50%). The analysis of sensitivity and subgroup was performed to explore the homogeneous studies among studies. The p-value of less than 0.05 was considered statistically significant.
30 RCT studies were included in this meta-analysis. There were significant difference of in the items of blood loss, screening time, femoral neck shortening, non-union, and femoral fractures (p < 0.05). Significant difference was found in the parameter of open reduction of fracture after sensitive analysis (p < 0.05). No significant difference was found in the parameter of Mobility Score at the last follow-up after sensitive analysis (p ≥ 0.05). There was no significant difference in the parameters of open reduction of fracture, required blood transfusion, mean surgical time, hospital stays, time to healing, mean Harris Hip Score, infection, cut out, poor reduction, breakage of implant, failure of fixation, reoperation, and systemic complications of chest infection, decubital ulcer, urinary tract infection and persistent pain in the hip (p ≥ 0.05).
Our meta-analysis revealed that hip fractures treated with IMN have merits with lower rate of blood loss, femoral neck shortening and non-union; shortcoming of increased risk of femoral fractures. It is suggested that special attention should be paid to the risk of femoral fracture when intramedullary nail was inserted in the intraoperative.
髋部骨折至今仍是未解决的问题。我们评估了治疗髋部骨折（AO/OTA31A1-A3）的功能结果和并发症，以发现髓内钉（IMN）和动力髋螺钉（DHS）之间的潜在差异和风险。
我们检索了 PubMed、Embase 和 Cochrane 图书馆，截至 2023 年 6 月 19 日，检索了比较 IMN 和 DHS 治疗髋部骨折的任何研究。从纳入的研究中提取主要结局和并发症。对于同质研究（I<50%），选择固定效应模型汇总数据；否则，选择随机效应模型（异质性，I>50%）。进行敏感性和亚组分析以探索研究中的同质研究。p 值小于 0.05 被认为具有统计学意义。
这项荟萃分析纳入了 30 项 RCT 研究。在出血量、筛选时间、股骨颈缩短、骨不连和股骨骨折等项目上存在显著差异（p<0.05）。在敏感分析后，骨折切开复位的参数有显著差异（p<0.05）。在敏感分析后最后一次随访时的活动评分参数无显著差异（p≥0.05）。骨折切开复位、需要输血、平均手术时间、住院时间、愈合时间、平均 Harris 髋关节评分、感染、切出、复位不良、植入物断裂、固定失败、再次手术以及胸部感染、褥疮、尿路感染和髋部持续性疼痛的全身并发症等参数无显著差异（p≥0.05）。
我们的荟萃分析表明，使用髓内钉治疗髋部骨折具有较低的失血量、股骨颈缩短和骨不连发生率的优点；缺点是股骨骨折的风险增加。建议在术中插入髓内钉时应特别注意股骨骨折的风险。
