不同内固定方式治疗Pauwels Ⅲ型股骨颈骨折术后并发症发生率的网状Meta分析-现代医学

不同内固定方式治疗Pauwels Ⅲ型股骨颈骨折术后并发症发生率的网状Meta分析

单位：南京医科大学附属无锡人民医院骨科, 江苏无锡 214023

分类号：R683.42，R687.3

出版年·卷·期（页码）：2024·52·第三期（369-378）

摘要：

目的：应用网状Meta分析的方法评价不同内固定方式治疗Pauwels Ⅲ型股骨颈骨折术后并发症发生率的情况。方法：计算机检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方、维普、SinoMed数据库中有关内固定方式治疗Pauwels Ⅲ型股骨颈骨折的随机对照试验和队列研究，纳入传统3枚平行空心钉、3枚空心钉结合内侧支撑钢板、动力髋螺钉联合防旋螺钉、股骨颈系统、4枚空心钉菱形分布、3枚空心钉“F”型分布、3枚空心钉联合1枚横向空心钉、横向松质骨拉力螺钉8种内固定方式，以术后股骨头坏死率和骨折不愈合发生率为观察指标，采用Stata 17.0软件进行Meta分析。结果：最终纳入文献43篇，其中随机对照试验12篇，回顾性队列研究31篇，共2 778例患者。普通Meta分析结果显示，相对于传统3枚平行空心钉，3枚空心钉结合内侧支撑钢板和3枚空心钉“F”型分布可降低术后股骨头坏死率，差异具有统计学意义(P＜0.05)；3枚空心钉结合内侧支撑钢板、4枚空心钉菱形分布、3枚空心钉联合1枚横向空心钉的内固定方式可降低术后骨折不愈合发生率，差异具有统计学意义(P＜0.05)。网状Meta分析结果显示，不同内固定方式在术后股骨头坏死率上由优到劣排序前2位为4枚空心钉菱形分布(79.5%)和股骨颈系统(68.3%)；在术后骨折不愈合发生率上由优到劣排序前2位为4枚空心钉菱形分布(73.9%)和3枚空心钉联合1枚横向空心钉(69.7%)。结论：在8种内固定方式中，4枚空心钉菱形分布在Pauwels Ⅲ型股骨颈骨折术后股骨头坏死率、骨折不愈合发生率排序均最优，提示其可能是临床治疗Pauwels Ⅲ型股骨颈骨折的最优选择，但仍需要更多大样本、多中心、双盲随机对照试验研究来进一步证实。

Objective: To evaluate the postoperative complication rate of Pauwels type Ⅲ femoral neck fracture treated by different internal fixation modalities using network Meta-analysis. Methods: Randomized controlled trials and cohort studies on internal fixation for Pauwels type Ⅲ femoral neck fracture were searched in PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, and SinoMed databases. The literature of the search results included traditional 3 cannulated screws, 3 cannulated screws combined with medial buttress plate, dynamic hip screw combine with anti- rotation screw, femoral neck system, 4 cannulated screws in diamond distribution, 3 cannulated screws in " F" type distribution, 3 cannulated screws combined with a transverse cannulated screw and transverse cancellous bone lag screw. Postoperative femoral head necrosis rate and fracture non- union rate as observational indicators, and Meta-analysis was performed using Stata 17. 0 software. Results: A total of 43 articles were included, comprising 12 randomized controlled trials and 31 retrospective cohort studies, with totaling 2 778 patients. The results of Meta-analysis suggested that compared with the traditional 3 cannulated screws, 3 cannulated screws combined with medial buttress plate and 3 cannulated screws in "F" type distribution could reduce the postoperative femoral head necrosis (P <0. 05). The internal fixation of 3 cannulated screws combined with medial buttress plate, 4 cannulated screws in diamond distribution and 3 cannulated screws combined with a transverse cannulated screws could reduce the incidence of fracture non- union, the results were statistically significant(P <0. 05). The results of the network Meta- analysis indicated that the top two different internal fixation modalities in order of superiority to inferiority in postoperative femoral head necrosis rate were 4 cannulated screws in diamond distribution(79. 5%) and femoral neck system(68. 3%). The top two rankings of different internal fixation modalities in terms of the incidence of postoperative fracture non-union were 4 cannulated screws in diamond distribution (73. 9%) and 3 cannulated screws combined with a transverse cannulated screw (69. 7%). Conclusion: Among the eight internal fixation modalities, 4 cannulated screws in diamond distribution was optimal in ranking the incidence of necrosis of the femoral head and fracture non- union after Pauwels type Ⅲ femoral neck fracture, suggesting that it may be the optimal choice for the clinical treatment of Pauwels type Ⅲ femoral neck fracture, but it still needs to be further confirmed by more large- sample, multicentre, double- blind randomized controlled trial studies.

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