[1]邝孝坤,田可为,范克杰,等.F形空心螺钉内固定术治疗股骨颈骨折有效性和安全性的Meta分析[J].中医正骨,2024,36(07):44-50.
　KUANG Xiaokun,TIAN Kewei,FAN Kejie,et al.Clinical outcomes and safety of F-shaped hollow screw internal fixation for treatment of femoral neck fracture:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(07):44-50.
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F形空心螺钉内固定术治疗股骨颈骨折有效性和安全性的Meta分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年07期
页码:
44-50
栏目:
文献研究
出版日期:
2024-07-20

文章信息/Info

Title:
Clinical outcomes and safety of F-shaped hollow screw internal fixation for treatment of femoral neck fracture:a meta-analysis
作者:
邝孝坤1; 田可为2; 范克杰2; 马文龙2; 刘英科1; 严嘉祥2; 田燃2; 陈柯2
1.河南中医药大学研究生院,河南 郑州 450046; 2.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
Author(s):
KUANG Xiaokun1; TIAN Kewei2; FAN Kejie2; MA Wenlong2; LIU Yingke1; YAN Jiaxiang2; TIAN Ran2; CHEN Ke2
1.Postgraduate College of Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China 2.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China.
关键词:
股骨颈骨折;  骨折固定术; 内;  骨螺丝;  专题Meta分析
Keywords:
femoral neck fractures;  fracture fixation; internal;  bone screws;  meta-analysis as topic
摘要:
目的:系统评价F形空心螺钉内固定术治疗股骨颈骨折(femoral neck fracture,FNF)的有效性和安全性。方法:检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Cochrane Library、Embase、Web of Science中比较F形空心螺钉内固定术(F形固定组)与3枚空心螺钉平行内固定术(平行固定组)治疗FNF有效性和安全性的随机对照试验和非随机对照试验,检索时限均为2011年1月1日至2024年5月1日。由2名研究人员独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Stata16.0软件进行Meta分析。结果:共纳入11项研究,其中非随机对照试验7项、随机对照试验4项; 共涉及846例患者,其中F形固定组425例、平行固定组421例。Meta分析结果显示,与平行固定组相比,F形固定组住院时间更短[MD=-2.45,95%CI(-3.42,-1.47),P=0.000]、复位满意率更高[OR=3.49,95%CI(1.88,6.48),P=0.000]、骨折愈合更快[MD=-0.72,95%CI(-0.93,-0.50),P=0.000]、末次随访髋部疼痛视觉模拟量表评分更低[MD=-2.07,95%CI(-2.39,-1.74),P=0.000]、末次随访Harris评分更高[MD=7.62,95%CI(3.52,11.71),P=0.000]、股骨头坏死发生率更低[OR=0.32,95%CI(0.17,0.61),P=0.001]、骨折不愈合发生率更低[OR=0.42,95%CI(0.23,0.78),P=0.006]、股骨颈短缩发生率更低[OR=0.40,95%CI(0.23,0.69),P=0.001]、内固定失效发生率更低[OR=0.25,95%CI(0.13,0.51),P=0.000]; 2组手术时间、术中出血量、术中X线透视时间的差异均无统计学意义。分别采用固定效应模型和随机效应模型对上述结局指标进行Meta分析,所得结果基本相似,表明研究结果稳健可靠。基于末次随访Harris评分进行发表偏倚分析,Egger's检验结果提示不存在发表偏倚(P=0.114)。结论:现有证据表明,相较于传统的3枚空心螺钉平行内固定术,采用F形空心螺钉内固定术治疗FNF临床疗效更好、安全性更高,且不会增加手术操作难度,也不会对患者造成额外创伤。
Abstract:
Objective:To systematically review the clinical outcomes and safety of F-shaped hollow screw internal fixation in treatment of femoral neck fracture(FNF).Methods:All the randomized controlled trial(RCT)and non-RCT articles about the clinical outcomes and safety of F-shaped hollow screw internal fixation(F-shaped fixation group)versus three hollow screws parallel internal fixation(parallel fixation group)for treatment of FNF included from January 1,2011 to May 1,2024 were retrieved from the China National Knowledge Infrastructure,Wanfang Database,Vip Database,Chinese Biomedical Literature Service System,PubMed,Cochrane Library,Embase and Web of Science.The pertinent articles were screened,the information was extracted and the risk of bias of the included researches was assessed independently by two researchers,and then a Meta-analysis was conducted by using Stata16.0 software.Results:Eleven articles(846 patients)were included in the final analysis,including 7 non-RCT articles,and 4 RCT articles.Four hundred and twenty-five patients in F-shaped fixation group,and 421 ones in parallel fixation group.The results of Meta-analysis revealed that the hospital stay was shorter,the reduction satisfaction rate and the Harris score measured at the last follow-up were higher,the fracture healing was faster,the hip pain visual analogue scale(VAS)score measured at the last follow-up and the incidence rates of femur head necrosis(FHN),fracture nonunion,femoral neck shortening and failed internal fixation were lower in F-shaped fixation group compared to parallel fixation group(MD=-2.45,95%CI(-3.42,-1.47),P=0.000; OR=3.49,95%CI(1.88,6.48),P=0.000; MD=7.62,95%CI(3.52,11.71),P=0.000; MD=-0.72,95%CI(-0.93,-0.50),P=0.000; MD=-2.07,95%CI(-2.39,-1.74),P=0.000; OR=0.32,95%CI(0.17,0.61),P=0.001; OR=0.42,95%CI(0.23,0.78),P=0.006; OR=0.40,95%CI(0.23,0.69),P=0.001; OR=0.25,95%CI(0.13,0.51),P=0.000); while,the differences in operative time,intraoperative blood loss,and intraoperative X-ray exposure were not statistically significant between the 2 groups.A re-evaluation was further performed on the aforementioned outcome indicators by employing a fixed-effect model and a random-effect model,respectively,and the results showcased that no evident change was found in the result of each outcome indicator,suggesting the results of the Meta-analysis in this study were relatively stable and reliable.Moreover,the publication bias was analyzed based on the Harris score measured at the last follow-up,and the result of Bgger's test showed that there was no publication bias in the included articles(P=0.114).Conclusion:Available evidences suggest that,compared to the traditional parallel internal fixation with three hollow screws,the F-shaped hollow screw internal fixation behaves better in clinical outcomes and safety in the treatment of FNF,without increasing the difficulty of surgical operation or causing additional trauma to the patients.

参考文献/References:

[1] WU H,LI Y,TONG L,et al.Worldwide research tendency and hotspots on hip fracture:a 20-year bibliometric analy-sis[J].Arch Osteoporos,2021,16(1):73.
[2] FILIPOV O.Biplane double-supported screw fixation(F-technique):a method of screw fixation at osteoporotic fractures of the femoral neck[J].Eur J Orthop Surg Traumatol,2011,21(7):539-543.
[3] FILIPOV O,STOFFEL K,GUEORGUIEV B,et al.Femoral neck fracture osteosynthesis by the biplane double-supported screw fixation method(BDSF)reduces the risk of fix-ation failure:clinical outcomes in 207 patients[J].Arch Orthop Trauma Surg,2017,137(6):779-788.
[4] JILANI L Z,ABBAS M B,SHAAN Z H,et al.Outcomes of BDSF technique for osteosynthesis of femoral neck frac-tures[J].Int J Burns Trauma,2023,13(3):149-155.
[5] SAMI A,PRABHAKAR R,KUMAR YADAV A,et al.Biplane double supported screw fixation for femoral neck fracture in young adults:a prospective cohort study[J].J Orthop,2022,33:117-123.
[6] FILIPOV O,GUEORGUIEV B.Unique stability of femoral neck fractures treated with the novel biplane double-supported screw fixation method:a biomechanical cadaver study[J].Injury,2015,46(2):218-226.
[7] LIN S,SHANG J,XING B,et al.Modified F configuration in the treatment of Pauwels typeⅢfemoral neck fracture:a finite element analysis[J].BMC Musculoskelet Disord,2021,22(1):758.
[8] 彭良贞,张凤海.F形空心钉固定与传统平行钉固定治疗股骨颈骨折患者的效果比较[J].国际医药卫生导报,2024,30(7):1142-1146.
[9] 赵兴龙,申建军,冯康虎,等.骨科机器人辅助下F钉技术与倒三角平行钉治疗不稳定型股骨颈骨折的疗效比较[J].中国骨伤,2024,37(2):129-134.
[10] 祝文发,刘鹏原,林贤梅,等.PauwelsⅢ型股骨颈骨折患者应用“F”形空心钉内固定术的治疗效果[J].中外医学研究,2023,21(20):38-42.
[11] 程文静,丁国正,谢家兵,等.F形空心钉与传统3枚平行钉治疗PauwelsⅢ型,股骨颈骨折的疗效比较[J].中国骨伤,2022,35(7):678-682.
[12] 陈建.关节镜辅助下复位联合经皮空心钉“F”形置钉技术内固定治疗股骨颈骨折的效果研究[J].吉林医学,2022,43(8):2086-2087.
[13] 陈方,刘修其,邓钰泓,等.空心拉力螺钉“F”形固定PauwelsⅢ型股骨颈骨折[J].中国矫形外科杂志,2022,30(10):954-957.
[14] 沈敏,曹晓东,顾建伟,等.双平面固定在股骨颈骨折稳定优化中的疗效分析[J].生物骨科材料与临床研究,2022,19(4):26-30.
[15] 贺延雷,李强,李国良.“F”形空心钉与空心螺钉内固定治疗股骨颈骨折的效果比较[J].医学信息,2020,33(8):113-115.
[16] 王建,冉建,刘修信,等.空心钉“F”技术与倒三角形方式布钉治疗股骨颈骨折的疗效比较[J].中国矫形外科杂志,2016,24(24):2242-2246.
[17] CAO D,YIN J,YU P,et al.Treatment of PauwelsIII femoral neck fracture in young patients using biplane double support screw internal fixation technology based on X-ray image[J].Med Eng Phys,2024,125:104135.
[18] GARG S,TANK G.Role of biplane double-supported screw fixation(BDSF)in management of fracture neck femur and its comparison with conventional CC screw fixation[J].Indian J Orthop,2023,57(12):2011-2017.
[19] LY T V,SWIONTKOWSKI M F.Treatment of femoral neck fractures in young adults[J].J Bone Joint Surg Am,2008,90(10):2254-2266.
[20] 中华医学会骨科学分会创伤骨科学组,中国医师协会骨科医师分会创伤专家工作委员会.成人股骨颈骨折诊治指南[J].中华创伤骨科杂志,2018,20(11):921-928.
[21] 刘英科,陈勤,陈柯,等.两种内固定治疗PauwelsⅢ型股骨颈骨折的疗效比较[J].临床骨科杂志,2024,27(2):247-251.
[22] 刘英科,马文龙,田可为,等.三种手术方式治疗中青年PauwelsⅢ型股骨颈骨折的疗效比较[J].中国修复重建外科杂志,2024,38(4):412-421.
[23] 沈正清,谢景凌,王旭东,等.空心钉结合内侧支撑钢板在PauwelsⅢ型股骨颈骨折中的应用[J].实用骨科杂志,2021,27(3):205-209.
[24] GARDEN R S.Low-angle fixation in fractures of the femoral neck[J].J Bone Joint Surg Br,1961,43(4):647-663.
[25] 许景红,汤志辉,毛成鹏,等.“F”形空心钉内固定技术治疗股骨颈骨折的有限元分析[J].实用骨科杂志,2018,24(6):516-518.
[26] 谭能贤,吴文正,郑楚荣,等.不同空心加压螺钉固定方式对股骨颈垂直型骨折的有限元分析[J].中国组织工程研究,2024,28(6):873-878.

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备注/Memo

备注/Memo:
基金项目:河南省医学科技攻关计划项目(LHGJ20230483); 河南省重点研发与推广专项项目(182102310467); 河南省中医药科学研究专项课题(20-21ZY2253,20-21ZY2238)
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更新日期/Last Update: 1900-01-01