CAJ | 학술논문

背景：越来越多的老年患者因各种原因出现髋部骨折，大部分骨折均为不稳定骨折，且合并小转子的移位，目前仍有许多报道使用动力髋螺钉修复股骨转子间不稳定骨折，效果明显，但是在修复过程中是否行小转子固定仍存在较大争议。目的：采用Meta分析的方法评价动力髋螺钉联合小转子固定修复股骨转子间骨折的效果及修复后髋内翻的发生情况。方法：计算机检索美国医学文摘数据库(PubMed)、FMJS 外文全文数据库(EMCC)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库维普(VIP)及万方数据库，收集动力髋螺钉置入内固定修复股骨转子间骨折过程中小转子复位固定与否的随机对照试验。按照事先制定的纳入与剔除标准，评价纳入研究的质量，提取有效数据，采用RevMan 5.2软件进行分析。结果与结论：共纳入10个随机对照试验，共604例患者，其中动力髋螺钉联合小转子固定组298例，小转子不固定组306例。Meta 分析结果显示，动力髋螺钉联合小转子固定组髋内翻、其他并发症、疗效优良率均优于小转子不固定组(P均<0.0001)，其中髋内翻为[OR=0.17，95%CI(0.07，0.41)，Z=3.99，P<0.0001]。小转子不固定组在手术时间、出血量方面均优于联合小转子固定组(P均<0.0001)。提示在动力髋螺钉置入内固定修复不稳定股骨转子间骨折时，小转子不固定治疗具有操作相对简单和手术时间短、出血量少等优点，但动力髋螺钉联合小转子固定修复 Tronzo-Evans Ⅲ型以上的转子间骨折在疗效优良率、髋内翻及其他并发症方面均优于小转子不固定。说明动力髋螺钉联合小转子固定有利于预防股骨转子间骨折修复后髋内翻等并发症的出现。
배경：월래월다적노년환자인각충원인출현관부골절，대부분골절균위불은정골절，차합병소전자적이위，목전잉유허다보도사용동력관라정수복고골전자간불은정골절，효과명현，단시재수복과정중시부행소전자고정잉존재교대쟁의。목적：채용Meta분석적방법평개동력관라정연합소전자고정수복고골전자간골절적효과급수복후관내번적발생정황。방법：계산궤검색미국의학문적수거고(PubMed)、FMJS 외문전문수거고(EMCC)、중국생물의학문헌수거고(CBM)、중국기간전문수거고(CNKI)、중문과기기간전문수거고유보(VIP)급만방수거고，수집동력관라정치입내고정수복고골전자간골절과정중소전자복위고정여부적수궤대조시험。안조사선제정적납입여척제표준，평개납입연구적질량，제취유효수거，채용RevMan 5.2연건진행분석。결과여결론：공납입10개수궤대조시험，공604례환자，기중동력관라정연합소전자고정조298례，소전자불고정조306례。Meta 분석결과현시，동력관라정연합소전자고정조관내번、기타병발증、료효우량솔균우우소전자불고정조(P균<0.0001)，기중관내번위[OR=0.17，95%CI(0.07，0.41)，Z=3.99，P<0.0001]。소전자불고정조재수술시간、출혈량방면균우우연합소전자고정조(P균<0.0001)。제시재동력관라정치입내고정수복불은정고골전자간골절시，소전자불고정치료구유조작상대간단화수술시간단、출혈량소등우점，단동력관라정연합소전자고정수복 Tronzo-Evans Ⅲ형이상적전자간골절재료효우량솔、관내번급기타병발증방면균우우소전자불고정。설명동력관라정연합소전자고정유리우예방고골전자간골절수복후관내번등병발증적출현。
BACKGROUND:More and more elderly patients have hip fractures because of diverse reasons, and most of the fractures are unstable fractures combined with the displacement of the lesser trochanter. At present, there are stil many reports about using dynamic hip screw to repair unstable intertrochanteric fractures, and the effect is obvious. However, there are stil great controversies regarding whether lesser trochanter fixation is performed during the repair process. OBJECTIVE:To evaluate the effect of using dynamic hip screw combined with the lesser trochanter fixation to repair intertrochanteric fractures and the occurrence of hip coxa vara after repair through a meta-analysis. METHODS:The PubMed, EMCC, CBM, CNKI, VIP and Wanfang databases were retrieved by computer for randomized controled trials on whether lesser trochanter reduction fixation was performed during the process of dynamic hip screw internal fixation for repair of intertrochanteric fractures. The quality of the included studies was evaluated according to the pre-designated inclusion and exclusion criteria. The available data were extracted and analyzed using the RevMan5.2 software. RESULTS AND CONCLUSION:A total of 10 randomized controled trials involving 604 patients were included. Among them, 298 cases were assigned to the dynamic hip screw combined with lesser trochanter fixation group, and 306 cases to the lesser trochanter unfixed group. The meta-analysis results indicated that hip coxa vara, other postoperative complications, the excelent and good rate of efficacy in the dynamic hip screw combined with lesser trochanter fixation group were al superior to those in the lesser trochanter unfixed group (alP < 0.000 1), and for hip coxa vara, the parameters were odds ratio=0.17, 95% confidence interval (0.07, 0.41),Z=3.99,P< 0.000 1. The operation time and the amount of blood loss in the lesser trochanter unfixed group were superior to those in the dynamic hip screw combined with lesser trochanter fixation group (alP < 0.000 1). These results suggest that the lesser trochanter unfixed therapy has the advantages of relatively simple operation, shorter operative time and less blood loss during the process of dynamic hip screw internal fixation for repair of unstable intertrochanteric fractures. However, the excelent and good rates of efficacy, hip coxa vara and other postoperative complications were superior in patients with intertrochanteric fracture above the Tronzo-Evans III type who received dynamic hip screw combined with lesser trochanter fixation to those who received lesser trochanter unfixed therapy. The results indicate that dynamic hip screw combined with lesser trochanter fixation for repair of intertrochanteric fracture is beneficial to prevent hip coxa vara and other complications.