CAJ | 학술논문

背景：髓外固定系统包括动力髋螺钉常用于治疗股骨转子间骨折；但在不稳定性股骨转子间骨折的患者中，髓外固定系统往往会导致骨折固定失败。髓内固定系统包括股骨近端抗旋髓内钉和联合加压交锁髓内钉系统广泛用于治疗不稳定性股骨转子间骨折。目的：比较髓外固定系统包括动力髋螺钉，股骨近端抗旋髓内钉和联合加压交锁髓内钉系统治疗股骨转子间骨折的疗效。方法：检索万方数据库、PubMed、Embase、Medline和Cochrone library从1990年1月到2014年11月的文献。对髓外固定系统包括动力髋螺钉，股骨近端抗旋髓内钉和联合加压交锁髓内钉系统的相关文献进行筛选。结果与结论：通过对346篇文献进行筛选，共有13篇文献符合标准，其中共纳入1271例不同类型的股骨转子间骨折患者。与髓外固定系统包括动力髋螺钉组相比，股骨近端抗旋髓内钉组和联合加压交锁髓内钉系统组患者手术时间更短，且出血量更少，但3种固定方法患者康复时间和愈后Harris评分差异无显著性意义。此外，股骨近端抗旋髓内钉和联合加压交锁髓内钉系统的疗效相似。提示与髓外固定系统包括动力髋螺钉相比，股骨近端抗旋髓内钉和联合加压交锁髓内钉系统虽可优化手术过程，但不能提升术后恢复效果。
배경：수외고정계통포괄동력관라정상용우치료고골전자간골절；단재불은정성고골전자간골절적환자중，수외고정계통왕왕회도치골절고정실패。수내고정계통포괄고골근단항선수내정화연합가압교쇄수내정계통엄범용우치료불은정성고골전자간골절。목적：비교수외고정계통포괄동력관라정，고골근단항선수내정화연합가압교쇄수내정계통치료고골전자간골절적료효。방법：검색만방수거고、PubMed、Embase、Medline화Cochrone library종1990년1월도2014년11월적문헌。대수외고정계통포괄동력관라정，고골근단항선수내정화연합가압교쇄수내정계통적상관문헌진행사선。결과여결론：통과대346편문헌진행사선，공유13편문헌부합표준，기중공납입1271례불동류형적고골전자간골절환자。여수외고정계통포괄동력관라정조상비，고골근단항선수내정조화연합가압교쇄수내정계통조환자수술시간경단，차출혈량경소，단3충고정방법환자강복시간화유후Harris평분차이무현저성의의。차외，고골근단항선수내정화연합가압교쇄수내정계통적료효상사。제시여수외고정계통포괄동력관라정상비，고골근단항선수내정화연합가압교쇄수내정계통수가우화수술과정，단불능제승술후회복효과。
BACKGROUND: The extramedulary fixation system including dynamic hip screw (DHS) is commonly used in treatment of Intertrochanteric fracture. However, in patients with unstable intertrochanteric fracture, extramedulary fixation system often leads to the failure of fracture fixation. Intramedulary fixation system including both proximal femoral nail antirotation (PFNA) and InterTan nail has been widely used in the treatment of unstable intertrochanteric fractures. OBJECTIVE:To compare the therapeutic effects of extramedulary fixation system containing DHS, PFNA and InterTan nail in the treatment of intertrochanteric fracture. METHODS:Literatures were searched in Wanfang, PubMed, Embase, Medline, the Cochrane library to screen literatures published from January 1990 to November 2014. Relevant studies addressing extramedulary fixation system containing DHS, PFNA and InterTan nail were screened. RESULTS AND CONCLUSION: 346 articles were screened, and 13 of them were in accordance with the inclusion criteria. 1 271 patients with different types of intertrochanteric fracture were assessed in this study. Compared to DHS group, patients treated with PFNA and InterTan nail had shorter operation time and less blood loss. No significant difference in rehabilitation time and Harris score was detected among three kinds of fixation methods. Additionaly, PFNA and InterTan nail had a similar effect. These findings verify that compared with DHS, PFNA and InterTan nail can optimize the surgery, but cannot elevate postoperative outcomes.