Sheffels Erin, Khalil Mariam, Hutchison Kristen, Hardy Nicole J, Tarchand Ranita, Pederson John M, Parikh Anjani, Blauth Michael
Superior Medical Experts, Inc, St. Paul, MN, USA.
Nested Knowledge, Inc., St. Paul, MN, USA.
Geriatr Orthop Surg Rehabil. 2024 Nov 15;15:21514593241273326. doi: 10.1177/21514593241273326. eCollection 2024.
Femoral neck fractures (FNF) represent a significant challenge in orthopedic practice, demanding prompt intervention to restore function and mobility in affected individuals. Numerous surgical interventions have been developed to address these fractures, including internal fixation with devices such as the Femoral Neck System (FNS, DePuy Synthes, Inc., West Chester, PA, USA). However, the optimal fixation system remains unclear. Understanding the postoperative outcomes associated with these interventions is crucial for optimizing patient care and informing treatment decisions.
This PRISMA-compliant systematic literature review evaluates the efficacy and safety of the Femoral Neck System relative to other operative treatment options. Clinical and safety outcomes included mortality, perioperative complications, postoperative complications at 1 year, and reoperation.
A total of 117 studies with 68,567 patients with FNF treated with internal fixation were identified. Of these, thirteen included FNS as a treatment arm (1078 patients). Due to heterogeneity in study designs and populations, only the eleven studies that directly compared FNS to other operative treatments, and 2 non-comparative studies that treated with FNS were included in the systematic review. Seven of the eleven included studies had high risk of bias, 2 had moderate risk of bias, and 2 had low risk of bias. FNS groups had similar or significantly lower incidences of postoperative complications, reoperations, and mortality compared to cannulated screw, cancellous screw, or dynamic or sliding hip screw groups in all studies.
FNS can be a safe and effective operative treatment option for FNF. Safety outcomes and reoperation rates are comparable between patients treated with FNS and patients treated with cannulated screws, cancellous screws, and dynamic or sliding hips screws. Future prospective, controlled studies are needed to confirm the safety and efficacy of FNS relative to other operative treatment options.
股骨颈骨折（FNF）是骨科临床面临的重大挑战，需要及时干预以恢复患者的功能和活动能力。目前已开发出多种手术干预方法来治疗这些骨折，包括使用股骨颈系统（FNS，美国宾夕法尼亚州韦斯特切斯特市迪普伊辛迪斯公司）等器械进行内固定。然而，最佳的固定系统仍不明确。了解这些干预措施的术后效果对于优化患者护理和指导治疗决策至关重要。
本项遵循PRISMA标准的系统文献综述评估了股骨颈系统相对于其他手术治疗方案的有效性和安全性。临床和安全结局包括死亡率、围手术期并发症、术后1年的并发症以及再次手术情况。
共纳入117项研究，涉及68567例接受内固定治疗的股骨颈骨折患者。其中，13项研究将FNS作为一个治疗组（1078例患者）。由于研究设计和人群的异质性，系统评价仅纳入了11项直接比较FNS与其他手术治疗方法的研究，以及2项采用FNS治疗的非对照研究。纳入的11项研究中，7项存在高偏倚风险，2项存在中度偏倚风险，2项存在低偏倚风险。在所有研究中，FNS组与空心钉、松质骨螺钉或动力髋螺钉或滑动髋螺钉组相比，术后并发症、再次手术和死亡率的发生率相似或显著降低。
FNS可能是治疗股骨颈骨折安全有效的手术选择。FNS治疗患者与空心钉、松质骨螺钉、动力髋螺钉或滑动髋螺钉治疗患者的安全结局和再次手术率相当。未来需要进行前瞻性对照研究，以证实FNS相对于其他手术治疗方案的安全性和有效性。
