CAJ | 학술논문

背景：股骨转子间骨折在治疗上选择何种方案仍存在较大争议。对于几种主流方法修复转子间骨折的疗效，已有大量的临床试验论著发表，但这些结果的评价缺乏独立性，可能存在变量及观察研究中无法测量的偏倚，因此使得相关研究进展受到了限制。目的：通过Meta分析比较防旋型股骨近端髓内钉、动力髋螺钉与人工全髋关节置换对老年股骨转子间骨折的修复效果。方法：计算机检索Cochrane图书馆、PubMed数据库、Web of Science数据库及中国生物医学文献数据库(CBM)，收集防旋型股骨近端髓内钉、动力髋螺钉与全髋关节置换修复老年股骨转子间骨折的随机对照试验，采用循证医学 Meta分析方法对患者 X射线曝光时间、治疗后并发症发生率、治疗后卧床时间、治疗后切口感染率、髋关节Harris评分、平均手术时间、术中出血、住院时间及手术切口长度进行综合评价。严格评价纳入标准及方法学质量并提取相关资料。统计学软件采用Cochrane协作网提供的RevMan 5.0。结果与结论：共纳入12个随机对照试验，共包含1454例患者。防旋型股骨近端髓内钉和动力髋螺钉内固定两种方法在平均手术时间、术中失血量、X 射线曝光时间、治疗后并发症发生率、治疗后卧床时间上差异有显著性意义(P <0.05)。防旋型股骨近端髓内钉固定和全髋关节置换两种方法在住院时间、治疗后并发症发生率、治疗后卧床时间上差异有显著性意义(P<0.05)。动力髋螺钉内固定和全髋关节置换两种方法在治疗后并发症发生率、治疗后卧床时间、髋关节Harris评分上差异有显著性意义(P <0.05)。提示在手术时间、术中出血量、住院时间、治疗后并发症、治疗后卧床时间上防旋型股骨近端髓内钉明显优于动力髋螺钉和全髋关节置换，具有明显优势；在X射线曝光时间上，动力髋螺钉要优于防旋型股骨近端髓内钉；但在住院时间、治疗后并发症、治疗后卧床时间方面，全髋关节置换要优于动力髋螺钉和防旋型股骨近端髓内钉。揹景：股骨轉子間骨摺在治療上選擇何種方案仍存在較大爭議。對于幾種主流方法脩複轉子間骨摺的療效，已有大量的臨床試驗論著髮錶，但這些結果的評價缺乏獨立性，可能存在變量及觀察研究中無法測量的偏倚，因此使得相關研究進展受到瞭限製。目的：通過Meta分析比較防鏇型股骨近耑髓內釘、動力髖螺釘與人工全髖關節置換對老年股骨轉子間骨摺的脩複效果。方法：計算機檢索Cochrane圖書館、PubMed數據庫、Web of Science數據庫及中國生物醫學文獻數據庫(CBM)，收集防鏇型股骨近耑髓內釘、動力髖螺釘與全髖關節置換脩複老年股骨轉子間骨摺的隨機對照試驗，採用循證醫學 Meta分析方法對患者 X射線曝光時間、治療後併髮癥髮生率、治療後臥床時間、治療後切口感染率、髖關節Harris評分、平均手術時間、術中齣血、住院時間及手術切口長度進行綜閤評價。嚴格評價納入標準及方法學質量併提取相關資料。統計學軟件採用Cochrane協作網提供的RevMan 5.0。結果與結論：共納入12箇隨機對照試驗，共包含1454例患者。防鏇型股骨近耑髓內釘和動力髖螺釘內固定兩種方法在平均手術時間、術中失血量、X 射線曝光時間、治療後併髮癥髮生率、治療後臥床時間上差異有顯著性意義(P <0.05)。防鏇型股骨近耑髓內釘固定和全髖關節置換兩種方法在住院時間、治療後併髮癥髮生率、治療後臥床時間上差異有顯著性意義(P<0.05)。動力髖螺釘內固定和全髖關節置換兩種方法在治療後併髮癥髮生率、治療後臥床時間、髖關節Harris評分上差異有顯著性意義(P <0.05)。提示在手術時間、術中齣血量、住院時間、治療後併髮癥、治療後臥床時間上防鏇型股骨近耑髓內釘明顯優于動力髖螺釘和全髖關節置換，具有明顯優勢；在X射線曝光時間上，動力髖螺釘要優于防鏇型股骨近耑髓內釘；但在住院時間、治療後併髮癥、治療後臥床時間方麵，全髖關節置換要優于動力髖螺釘和防鏇型股骨近耑髓內釘。
배경：고골전자간골절재치료상선택하충방안잉존재교대쟁의。대우궤충주류방법수복전자간골절적료효，이유대량적림상시험론저발표，단저사결과적평개결핍독립성，가능존재변량급관찰연구중무법측량적편의，인차사득상관연구진전수도료한제。목적：통과Meta분석비교방선형고골근단수내정、동력관라정여인공전관관절치환대노년고골전자간골절적수복효과。방법：계산궤검색Cochrane도서관、PubMed수거고、Web of Science수거고급중국생물의학문헌수거고(CBM)，수집방선형고골근단수내정、동력관라정여전관관절치환수복노년고골전자간골절적수궤대조시험，채용순증의학 Meta분석방법대환자 X사선폭광시간、치료후병발증발생솔、치료후와상시간、치료후절구감염솔、관관절Harris평분、평균수술시간、술중출혈、주원시간급수술절구장도진행종합평개。엄격평개납입표준급방법학질량병제취상관자료。통계학연건채용Cochrane협작망제공적RevMan 5.0。결과여결론：공납입12개수궤대조시험，공포함1454례환자。방선형고골근단수내정화동력관라정내고정량충방법재평균수술시간、술중실혈량、X 사선폭광시간、치료후병발증발생솔、치료후와상시간상차이유현저성의의(P <0.05)。방선형고골근단수내정고정화전관관절치환량충방법재주원시간、치료후병발증발생솔、치료후와상시간상차이유현저성의의(P<0.05)。동력관라정내고정화전관관절치환량충방법재치료후병발증발생솔、치료후와상시간、관관절Harris평분상차이유현저성의의(P <0.05)。제시재수술시간、술중출혈량、주원시간、치료후병발증、치료후와상시간상방선형고골근단수내정명현우우동력관라정화전관관절치환，구유명현우세；재X사선폭광시간상，동력관라정요우우방선형고골근단수내정；단재주원시간、치료후병발증、치료후와상시간방면，전관관절치환요우우동력관라정화방선형고골근단수내정。
BACKGROUND:The methods to treat intertrochanteric fracture are controversial. A large number of clinical studies concern the therapeutic effects of several popular methods to repair intertrochanteric fracture, but these results lack of independence, and may have bias that cannot be measured in the variable and observational studies. Thus, relevant studies have been limited. OBJECTIVE:To compare the repair effects of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty on intertrochanteric fracture in aged patients by meta-analysis. METHODS: Four electronic databases were searched, including Cochrane library, PubMed, Web of Science and Chinese BioMedical Literature Database, to colect al randomized controled trials concerning the treatment of intertrochanteric fractures in the elderly with proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty. Using meta-analysis of evidence-based medicine, X-ray exposure time, postoperative complication rate, postoperative bed time, postoperative wound infection rate, Harris hip scores, mean operation time, intraoperative blood loss, length of hospital stays and length of the incision were compared and evaluated. Standard and methodology quality of the trials were criticaly assessed and relative data were extracted. This study used the Review Manager 5.0 software provided by Cochrane colaboration network. RESULTS AND CONCLUSION:Twelve randomized controled trials with 1 454 patients were included. Significant differences in mean operation time, intraoperative blood loss, X-ray exposure time, postoperative complication rate, and postoperative bed time were detected between the proximal femoral nail anti-rotation and dynamic hip screw groups (P < 0.05). Significant differences in length of hospital stays, postoperative complication rate, and postoperative bed time were observed between the proximal femoral nail anti-rotation and total hip arthroplasty groups (P < 0.05). Significant differences in postoperative complication rate, postoperative bed time, and Harris hip scores were detectable between the dynamic hip screw and total hip arthroplasty groups (P < 0.05). These data confirm that proximal femoral nail anti-rotation was apparently better than dynamic hip screw and total hip arthroplasty in operation time, intraoperative blood loss, length of hospital stays, postoperative complication rate, and postoperative bed time. Dynamic hip screw was better than proximal femoral nail anti-rotation in X-ray exposure time. Total hip arthroplasty was better than dynamic hip screw and proximal femoral nail anti-rotation in length of hospital stays, postoperative complication rate and postoperative bed time.