摘要
目的评价Gamma钉和DHS(DynamicHipScrew)/Richard钉治疗股骨近端骨折的疗效和安全性。方法应用Cochrance协作网Meta分析方法对关于Gamma钉和DHS/Richard钉治疗股骨近端骨折的随机或半随机对照试验进行Meta分析。结果我们检索出1969～2003年间发表的88篇关于Gamma钉和DHS/Richard钉治疗股骨近端骨折相比较的文献,经过筛选和评价,最后收集到已发表的7篇(共1256例患者)随机或半随机对照试验,符合本次Meta分析所纳入的试验标准。4个临床试验共包括621例患者,提供了关于术后前6个月的死亡率的详细信息。我们发现Gamma钉术后头6个月与DHS/Richard钉相比较的死亡的相对危险度无明显统计学差异(相对危险度1.17,P=0.51)。6个试验包括1083例患者提供了并发症的资料。Gamma钉和DHS/Richard钉内固定的相对危险度是1.41(P=0.02)。Gamma钉明显的增加了股骨干骨折的危险(相对危险度6.99;P=0.00),二次手术率增加(相对危险度1.85;P=0.20)。此外,Gamma钉与DHS/Richard钉相比较,患者的手术时间缩短,手术失血量及术后功能恢复相同。结论通过此次Meta分析发现,对于治疗股骨近端骨折,Gamma钉与DHS/Richard钉相比较,在死亡率、伤口感染率、手术失血量、术后功能的相对危险度无明显统计学差异,但增加并发症。
Objective To asses the effects of Gamma nail and DHS/Richard (dynamic hip screw) in the treatment of proximal femoral fractures. Methods A meta analysis of all the relevant randomized controlled trials (RCTs) was performed. We included randomized and quasi randomized controlled trials in patients with proximal femoral fracture to compare Gamma nail and DHS/Richard. Results First we identified 88 papers on comparison of Gamma nail and DHS/Richard in the treatment of proximal femoral fractures published from 1969 to 2003. 7 trials involving 1256 patients were identified as meeting all the eligibility criteria. 3 investigators independently graded study quality and abstracted relevant data, including information on mortality rates, wound infection, function, revision in patients with a proximal femoral fracture. 4 trials, which included a total of 621 patients, provided detailed information on mortality rates over the first 6 postoperative months. We found there was no significant difference in the relative risk of death in the first 6 months postoperative between treatments of Gamma nail and those of compression hip screw (relative risk 1.17;P=0.51). 6 trials that included a total of 1083 patients provided data on operative complications. The risk of operative complications from Gamma nail fixation appeared to be higher than that from compression screw and side plate fixation but not higher than that from compression hip screw (relative risk 1.41; P=0.02). We also found an obvious increase in the relative risk of fracture of femoral shaft between Gamma nail and compression hip screw (relative risk 6.99; P=0.00). Patients treated with Gamma nail had a higher rate of revision compared with those with compression hip screw, but there was no significant difference between the two groups (relative risk 1.85; P=0.20). In addition, wound infection, operative blood loss and functional recovery were similar between the tow groups(relative risk 0.98 for wound infection and 1.02 for function). Operating time for Gamma nail patients was significantly less than that for DHS/Richard ones (P< 0.05). Conclusions In comparison with dynamic hip screw in the treatment of proximal femoral fractures, the Gamma nail significantly increases the risk of operative complications, especially fracture of femoral shaft, but significantly reduces the operating time. There is no significant difference in early mortality rate, wound infection rate, operative blood loss, and postoperative function.
出处
《中华创伤骨科杂志》
CAS
CSCD
2004年第5期520-524,共5页
Chinese Journal of Orthopaedic Trauma
