Chantal Backman, Ashley Lam, Rosie Papp, Aurelie Tonjock Kolle, Franciely Daina Engel, Wenshan Li, Soha Shah, Colleen Webber, Peter Tanuseputro, Marie-Cecile Domecq, Steve Papp
{"title":"比较髓内钉与动力髋螺钉治疗股骨粗隆间骨折的术后康复效果——系统回顾和荟萃分析。","authors":"Chantal Backman, Ashley Lam, Rosie Papp, Aurelie Tonjock Kolle, Franciely Daina Engel, Wenshan Li, Soha Shah, Colleen Webber, Peter Tanuseputro, Marie-Cecile Domecq, Steve Papp","doi":"10.1177/21514593251350490","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>We conducted a systematic review and meta-analysis to compare post-operative rehabilitation outcomes between two common treatments in patients who have suffered an intertrochanteric hip fracture: intramedullary nails vs dynamic hip screws.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to August 10, 2022. The inclusion criteria were defined as Population: adults (>18 years old); Interventions/Comparators: intramedullary nails and dynamic hip screws; Outcomes: function, quality of life and survival; and Study type: randomized controlled trials and non-randomized studies. A meta-analysis was performed, and the fixed-effect model was selected to pool the data for homogeneous studies (I<sup>2</sup> < 50%) and the random effect model was selected for heterogeneity I<sup>2</sup>>50%. The <i>P</i>-value of less than 0.05 was considered statistically significant. A narrative synthesis was conducted on the remaining outcomes with insufficient data (ie, missing means, or standard deviations).</p><p><strong>Results: </strong>108 studies were included in the review. 42 studies had outcomes that were included in the meta-analysis. There were modest differences after sensitivity analysis for the Parker mobility score mean difference (MD) = 0.70, 95% CI [0.12, 1.28], T = 3.11, df = 5, <i>P</i> = 0.03, and Harris hip score (MD = 0.94, 95% CI [0.34, 1.54], T = 3.54, df = 9, <i>P</i> = 0.006) favoring the nails. There were no statistically significant differences in the Functional Independence Measure (FIM) (MD = -2.50, 95% CI [-6.46, 1.45], Z = 1.24, <i>P</i> = 0.22), the Barthel Index (MD = 2.66, 95% CI [-7.60, 12.92], T = 1,12, df = 2, <i>P</i> = 0.38), the generic quality of life (MD = 0.04, 95% CI [-0.08, 0.17], Z = 0.70, <i>P</i> = 0.49), the health-related quality of life (MD = -0.14, 95% CI [-3.57, 3.28], Z = 0.08, <i>P</i> = 0.93) or mortality (1.00, 95% CI [0.96, 1.03], Z = 0.16, <i>P</i> = 0.87) outcomes.</p><p><strong>Conclusion: </strong>This review showed some differences in functional outcomes in the treatment of intertrochanteric fractures favoring intramedullary nails over dynamic hip screws. There were no differences between the groups for quality of life and mortality outcomes. The narrative synthesis showed additional outcomes that warrant further investigations.</p>","PeriodicalId":48568,"journal":{"name":"Geriatric Orthopaedic Surgery & Rehabilitation","volume":"16 ","pages":"21514593251350490"},"PeriodicalIF":1.6000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174732/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparing Intramedullary Nails versus Dynamic Hip Screws in the Treatment of Intertrochanteric Hip Fractures on Post-operative Rehabilitation Outcomes - A Systematic Review and Meta-Analysis.\",\"authors\":\"Chantal Backman, Ashley Lam, Rosie Papp, Aurelie Tonjock Kolle, Franciely Daina Engel, Wenshan Li, Soha Shah, Colleen Webber, Peter Tanuseputro, Marie-Cecile Domecq, Steve Papp\",\"doi\":\"10.1177/21514593251350490\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>We conducted a systematic review and meta-analysis to compare post-operative rehabilitation outcomes between two common treatments in patients who have suffered an intertrochanteric hip fracture: intramedullary nails vs dynamic hip screws.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to August 10, 2022. The inclusion criteria were defined as Population: adults (>18 years old); Interventions/Comparators: intramedullary nails and dynamic hip screws; Outcomes: function, quality of life and survival; and Study type: randomized controlled trials and non-randomized studies. A meta-analysis was performed, and the fixed-effect model was selected to pool the data for homogeneous studies (I<sup>2</sup> < 50%) and the random effect model was selected for heterogeneity I<sup>2</sup>>50%. The <i>P</i>-value of less than 0.05 was considered statistically significant. A narrative synthesis was conducted on the remaining outcomes with insufficient data (ie, missing means, or standard deviations).</p><p><strong>Results: </strong>108 studies were included in the review. 42 studies had outcomes that were included in the meta-analysis. There were modest differences after sensitivity analysis for the Parker mobility score mean difference (MD) = 0.70, 95% CI [0.12, 1.28], T = 3.11, df = 5, <i>P</i> = 0.03, and Harris hip score (MD = 0.94, 95% CI [0.34, 1.54], T = 3.54, df = 9, <i>P</i> = 0.006) favoring the nails. There were no statistically significant differences in the Functional Independence Measure (FIM) (MD = -2.50, 95% CI [-6.46, 1.45], Z = 1.24, <i>P</i> = 0.22), the Barthel Index (MD = 2.66, 95% CI [-7.60, 12.92], T = 1,12, df = 2, <i>P</i> = 0.38), the generic quality of life (MD = 0.04, 95% CI [-0.08, 0.17], Z = 0.70, <i>P</i> = 0.49), the health-related quality of life (MD = -0.14, 95% CI [-3.57, 3.28], Z = 0.08, <i>P</i> = 0.93) or mortality (1.00, 95% CI [0.96, 1.03], Z = 0.16, <i>P</i> = 0.87) outcomes.</p><p><strong>Conclusion: </strong>This review showed some differences in functional outcomes in the treatment of intertrochanteric fractures favoring intramedullary nails over dynamic hip screws. There were no differences between the groups for quality of life and mortality outcomes. The narrative synthesis showed additional outcomes that warrant further investigations.</p>\",\"PeriodicalId\":48568,\"journal\":{\"name\":\"Geriatric Orthopaedic Surgery & Rehabilitation\",\"volume\":\"16 \",\"pages\":\"21514593251350490\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174732/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Geriatric Orthopaedic Surgery & Rehabilitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/21514593251350490\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Geriatric Orthopaedic Surgery & Rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/21514593251350490","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:我们进行了一项系统回顾和荟萃分析,比较股骨粗隆间骨折患者的两种常见治疗方法:髓内钉与动态髋螺钉的术后康复结果。方法:检索到2022年8月10日的MEDLINE、EMBASE、Cochrane Central Register of Controlled Trials和Web of Science。纳入标准定义为:人群:成人(bb0 ~ 18岁);干预措施/比较:髓内钉和动态髋螺钉;结果:功能、生活质量和生存率;研究类型:随机对照试验和非随机研究。进行meta分析,对于同质性研究(I2 < 50%)选用固定效应模型,对于异质性研究(I2 bb0 50%)选用随机效应模型。p值小于0.05认为有统计学意义。对剩余数据不足(即缺少均值或标准差)的结果进行叙事综合。结果:纳入108项研究。42项研究的结果被纳入meta分析。敏感性分析后,Parker活动评分的平均差异(MD) = 0.70, 95% CI [0.12, 1.28], T = 3.11, df = 5, P = 0.03, Harris髋关节评分(MD = 0.94, 95% CI [0.34, 1.54], T = 3.54, df = 9, P = 0.006)有利于指甲。没有在统计上有显著差异的功能独立性测量(鳍)(MD = -2.50, 95% CI [-6.46, 1.45], Z = 1.24, P = 0.22), Barthel指数(MD = 2.66, 95% CI [-7.60, 12.92], T = 1, 12日,df = 2, P = 0.38),一般的生活质量(MD = 0.04, 95% CI [-0.08, 0.17], Z = 0.70, P = 0.49),健康相关的生活质量(MD = -0.14, 95% CI [-3.57, 3.28], Z = 0.08, P = 0.93)或死亡率(1.00,95%可信区间[0.96,1.03],Z = 0.16, P = 0.87)的结果。结论:本综述显示在治疗股骨粗隆间骨折时,髓内钉优于动力髋螺钉在功能预后上存在一些差异。两组之间的生活质量和死亡率结果没有差异。叙事综合显示了值得进一步调查的其他结果。
Comparing Intramedullary Nails versus Dynamic Hip Screws in the Treatment of Intertrochanteric Hip Fractures on Post-operative Rehabilitation Outcomes - A Systematic Review and Meta-Analysis.
Objective: We conducted a systematic review and meta-analysis to compare post-operative rehabilitation outcomes between two common treatments in patients who have suffered an intertrochanteric hip fracture: intramedullary nails vs dynamic hip screws.
Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to August 10, 2022. The inclusion criteria were defined as Population: adults (>18 years old); Interventions/Comparators: intramedullary nails and dynamic hip screws; Outcomes: function, quality of life and survival; and Study type: randomized controlled trials and non-randomized studies. A meta-analysis was performed, and the fixed-effect model was selected to pool the data for homogeneous studies (I2 < 50%) and the random effect model was selected for heterogeneity I2>50%. The P-value of less than 0.05 was considered statistically significant. A narrative synthesis was conducted on the remaining outcomes with insufficient data (ie, missing means, or standard deviations).
Results: 108 studies were included in the review. 42 studies had outcomes that were included in the meta-analysis. There were modest differences after sensitivity analysis for the Parker mobility score mean difference (MD) = 0.70, 95% CI [0.12, 1.28], T = 3.11, df = 5, P = 0.03, and Harris hip score (MD = 0.94, 95% CI [0.34, 1.54], T = 3.54, df = 9, P = 0.006) favoring the nails. There were no statistically significant differences in the Functional Independence Measure (FIM) (MD = -2.50, 95% CI [-6.46, 1.45], Z = 1.24, P = 0.22), the Barthel Index (MD = 2.66, 95% CI [-7.60, 12.92], T = 1,12, df = 2, P = 0.38), the generic quality of life (MD = 0.04, 95% CI [-0.08, 0.17], Z = 0.70, P = 0.49), the health-related quality of life (MD = -0.14, 95% CI [-3.57, 3.28], Z = 0.08, P = 0.93) or mortality (1.00, 95% CI [0.96, 1.03], Z = 0.16, P = 0.87) outcomes.
Conclusion: This review showed some differences in functional outcomes in the treatment of intertrochanteric fractures favoring intramedullary nails over dynamic hip screws. There were no differences between the groups for quality of life and mortality outcomes. The narrative synthesis showed additional outcomes that warrant further investigations.
期刊介绍:
Geriatric Orthopaedic Surgery & Rehabilitation (GOS) is an open access, peer-reviewed journal that provides clinical information concerning musculoskeletal conditions affecting the aging population. GOS focuses on care of geriatric orthopaedic patients and their subsequent rehabilitation. This journal is a member of the Committee on Publication Ethics (COPE).