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不同手术干预措施治疗股骨不稳定转子间骨折的效果比较：网状 Meta 分析。

Different surgical interventions for unstable intertrochanteric fracture of the femur: Network meta-analysis.

机构信息

Department of Rehabilitative, Quzhou Second People's Hospital, Zhejiang, China.

Department of Oncology, Quzhou Second People's Hospital, Zhejiang, China.

出版信息

Medicine (Baltimore). 2024 Sep 13;103(37):e39676. doi: 10.1097/MD.0000000000039676.

DOI:10.1097/MD.0000000000039676
PMID:39287232
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11404887/
Abstract

OBJECTIVE

Although a large body of evidence has reported on surgical approaches for the treatment of unstable intertrochanteric femoral fractures, studies that comprehensively evaluate treatment outcomes are limited. The purpose of this study was to compare the effectiveness of extramedullary fixation (i.e., dynamic hip screw [DHS]), intramedullary fixation (i.e., the proximal femoral nailing [PFN]), and hemiarthroplasty (HA) for the treatment of unstable intertrochanteric femoral fractures using network meta-analysis.

METHODS

This study meets the preferred reporting items for systematic reviews and meta-analyses criteria. The Patient, Intervention, Comparison and Outcome search protocol framework was used to search the Google Scholar, PubMed, Embase, and Cochrane Library databases were searched from inception until June 2023.

RESULTS

A total of 15 randomized controlled trials, including 1282 patients were analyzed. The Harris hip score (HHS) after DHS fixation was the lowest compared with that of PFN fixation and HA. DHS fixation had a significantly longer operation time than that of PFN fixation. Compared with HA, a lower incidence of superficial wound infection was observed with PFN and DHS fixations. PFN was significantly more likely to be implant cut out compared with HA. Compared with DHS, PFN and HA showed a lower incidence of fracture healing malunion.

CONCLUSION

HA and PFN have good efficacy in improving the HHS and preventing joint deformities. However, HA showed a higher incidence of superficial infection than that observed with PFN, whereas a higher risk of screw cutout is observed with PFN than with HA.

摘要

目的

尽管大量证据报道了治疗不稳定型股骨转子间骨折的手术方法，但综合评估治疗效果的研究有限。本研究旨在通过网络荟萃分析比较髓外固定（即动力髋螺钉 [DHS]）、髓内固定（即股骨近端髓内钉 [PFN]）和半髋关节置换术（HA）治疗不稳定型股骨转子间骨折的效果。

方法

本研究符合系统评价和荟萃分析的首选报告项目标准。使用患者、干预、比较和结局搜索方案框架，从开始到 2023 年 6 月，在 Google Scholar、PubMed、Embase 和 Cochrane Library 数据库中进行了搜索。

结果

共分析了 15 项随机对照试验，包括 1282 名患者。与 PFN 固定和 HA 相比，DHS 固定后的 Harris 髋关节评分（HHS）最低。DHS 固定的手术时间明显长于 PFN 固定。与 HA 相比，PFN 和 DHS 固定的浅表伤口感染发生率较低。与 HA 相比，PFN 更有可能发生植入物穿出。与 DHS 相比，PFN 和 HA 骨折愈合畸形愈合的发生率较低。

结论

HA 和 PFN 在改善 HHS 和预防关节畸形方面均有良好的疗效。然而，HA 引起的浅表感染发生率高于 PFN，而 PFN 发生螺钉穿出的风险高于 HA。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/56d1f7845a47/medi-103-e39676-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/78108ed704a7/medi-103-e39676-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/e0bfd4138568/medi-103-e39676-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/3637fab217cf/medi-103-e39676-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/dff629fe59b3/medi-103-e39676-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/a39c8dd9bc66/medi-103-e39676-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/56d1f7845a47/medi-103-e39676-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/78108ed704a7/medi-103-e39676-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/e0bfd4138568/medi-103-e39676-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/3637fab217cf/medi-103-e39676-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/dff629fe59b3/medi-103-e39676-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/a39c8dd9bc66/medi-103-e39676-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6c2/11404887/56d1f7845a47/medi-103-e39676-g006.jpg

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