Baumann Anthony N, Uhler Mathias A, Fiechter Jay, Anastasio Albert T, Walley Kempland C, Coscia Atticus, Hake Mark E
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
College of Biological Sciences, University of Akron, Akron, OH, USA.
Arch Orthop Trauma Surg. 2024 Dec 23;145(1):89. doi: 10.1007/s00402-024-05723-6.
Distal femur fractures (DFF) are frequently treated surgically with single traditional constructs (STC), such as with a lateral plate or intramedullary nail, although nail-plate combination constructs (NPCC) are gaining attention. The purpose of this study is to compare outcomes between NPCC and STC for surgical fixation of DFF to guide surgeon decision-making.
Data Sources: This study is a systematic review and meta-analysis using PubMed, CINAHL, MEDLINE, Web of Science, Science Direct, and SPORTDiscus from database inception until January 10th, 2024.
Inclusion criteria were comparative studies that examined clinical outcomes and complications for NPCC versus STC for DFF in adult patients.
Data included operative time, estimated blood loss (EBL), length of stay (LOS), as well as likelihood of total complications, total unplanned reoperations, and malunion.
Statistical analysis included a random-effects model using unstandardized mean difference or odds ratio (OR).
Five retrospective comparative studies (n = 1,368 patients; mean age: 52.3 ± 8.1 years; 134 patients in the NPCC group) were included. There was no statistically significant difference in operative time (p = 0.696), EBL (p = 0.408), or LOS (p = 0.963) between patients in the NPCC group as compared to patients in the STC group after DFF. Patients in the NPCC group had a statistically significant lower number of total complications (p = 0.009; OR: 0.31; 10.6% versus 16.0%) and total unplanned reoperations (p = 0.027; OR: 0.42; 8.2% versus 14.8%) as compared to patients in the STC group after DFF. However, there was no statistically significant difference in the number of malunion cases between groups (p = 0.130), although the NPCC group had far fewer cases than the STC group (2.9% versus 10.5%).
Patients treated with NPCC had significantly fewer cases of total complications and total unplanned reoperations without significant differences in operative time, EBL, or LOS as compared to patients treated with STC for DFF, although these associations are limited by sample size.
Level IV.
股骨远端骨折（DFF）通常采用单一传统固定方式（STC）进行手术治疗，如使用外侧钢板或髓内钉，尽管钉板联合固定方式（NPCC）正受到关注。本研究的目的是比较NPCC和STC在DFF手术固定中的疗效，以指导外科医生的决策。
数据来源：本研究是一项系统评价和荟萃分析，使用了从数据库建立至2024年1月10日的PubMed、CINAHL、MEDLINE、Web of Science、Science Direct和SPORTDiscus数据库。
纳入标准为比较NPCC与STC在成年患者DFF中的临床疗效和并发症的对照研究。
数据包括手术时间、估计失血量（EBL）、住院时间（LOS），以及总并发症、总非计划再次手术和骨不连的发生率。
统计分析采用随机效应模型，使用非标准化均数差或比值比（OR）。
纳入了五项回顾性对照研究（n = 1368例患者；平均年龄：52.3±8.1岁；NPCC组134例患者）。DFF后，NPCC组患者与STC组患者相比，手术时间（p = 0.696）、EBL（p = 0.408）或LOS（p = 0.963）无统计学显著差异。与DFF后STC组患者相比，NPCC组患者的总并发症（p = 0.009；OR：0.31；10.6%对16.0%）和总非计划再次手术（p = 0.027；OR：0.42；8.2%对14.8%）数量在统计学上显著更低。然而，两组间骨不连病例数无统计学显著差异（p = 0.130），尽管NPCC组的病例数远少于STC组（2.9%对10.5%）。
与DFF后接受STC治疗的患者相比，接受NPCC治疗的患者总并发症和总非计划再次手术的病例数显著更少，手术时间、EBL或LOS无显著差异，尽管这些关联受样本量限制。
四级。
