40-股骨近端防旋髓內釘与动力髋螺钉治疗股骨粗隆间骨折临床疗效比较的Meta分析 二院 刘丙根.doc

股骨近端防旋髓内钉与动力髋螺钉治疗股骨粗隆间骨折临床疗效比较的Meta分析 刘丙根 庞清江 [摘要]目的：探讨股骨近端防旋髓内钉(proximal femoral nail anti-rotation，PFNA)与动力髋螺钉(dynamic hip screw，DHS)固定治疗股骨粗隆间骨折的临床疗效及安全性。方法：运用计算机检索Cochrane图书馆（2014年1期）、Pudmed、OVID、Elsevier、CNKI及万方等数据库以及手工检索相关文献的参考文献。所有的检索都从(1969-01/2013-12)年有关PFNA与DHS固定比较治疗股骨粗隆间骨折随机对照试验（RCTs）的英文及中文文献，筛选出符合纳入标准的文献，并对其进行严格的质量评价。利用Cochrane 协作网提供的RevMan5.0软件对纳入研究结果进行Meta分析，并对数据进行异质性检验。结果：共纳入20项随机对照试验，共958例患者，其中PFNA组787例，DHS组802例。资料分析显示，PFNA固定与 DHS 固定比较，手术时间缩短（P0.05）、术中失血量减少（P0.05）、术后髋内翻发生率（P0.05）、术后内固定失效发生率降低（P0.05）。结论：PFNA固定组与DHS固定组比较中，PFNA 固定在手术时间、住院时间、术后骨折愈合时间、术后引流量、术中出血量、术后总并发症发生率、术后髋内翻发生率、其它并发症发生率以及术后内固定失败发生率方面均优于DHS固定；但在术后骨折发生率、术后浅表切口感染发生率和术后Harris 评分优良率上两组的差异无统计学意义。 关键词：股骨粗隆间骨折，内固定，DHS，PFNA， Meta分析 Meta-analysis the clinica outcomes between the proximal femoral nail anti-rotation and dynamic hip screw in the treatment of intertrochanteric fractures Abstract [Objective] To compare the clinical efficacy of proximal femoral nail anti-rotation (PFNA) versus dynamic hip screw (DHS) in the treatment of intertrochanteric fractures .[Method] Reports of studies using randomized controlled trials (RCT) to compare PFNA with DHS in the management of intertrochanteric fractures were retrieved from the Cochrane Library(Issue 1 2014), Pudmed (1969-01/2013-12),OVID(1969-01/2013-12) Elsevier (1969-01/ 2013-12) , Wanfang Data(1969-01/2013-12), CNKI(1969-01 /2013-12),Furthermore , we also searched manually relevant references . And its strict quality assessment. The analysis was performed with software RevMan5.0 from the Cochrane collaboration. Additionally ,the analysis will check the heterogeneity of data. [Results] A total of 20 related papers ( involving 1589 cases) were included in this analysis. The PFNA group consisted of 787 cases，and the DHS group consisted of 802 cases . The results showed that, compared with DHS, PFNA significantly decreased the duration of surgery（P0.05）, intraoperative blood loss（P0.05）, the rate of post-operative coxa vara（P0.05）,the