外侧壁重建在改善股骨粗隆间骨折手术效果中的作用

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-24 DOI:10.1002/jeo2.70385

Sanaz Bordbar, Mehdi Komijani, Fereshteh Eidy, Mohammad Hossein Nabian, Leila Zanjani

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引用次数: 0

摘要

股骨转子间骨折是股骨近端骨折中最常见的类型，约33%的病例发生外侧骨折。本荟萃分析比较了髓内固定方法，特别是股骨近端钉（PFN）和股骨近端钉防旋转（PFNA）与其他治疗方案的有效性。方法采用PubMed、Scopus、Web of Science和Embase数据库，按照PRISMA指南进行系统评价。我们纳入了累及外侧壁的股骨粗隆间骨折的临床试验。随机效应模型用于分析不同治疗方法的平均差异，统计评估包括I²、科克伦Q值、敏感性分析和Egger检验。此外，进行了亚组分析。在最初的1009项结果中，纳入了10项研究，涉及516名患者。评估的手术方法包括PFN/PFNA、PFN加转子支撑钢板、螺钉增强PFN、PFNA加滑动加压钢板和InterTan。实验模型的失血量显著增加（MD: 31.83, 95%可信区间[CI]: 0.28-63.38, p < 0.001, I²= 99%）。实验模型的联合时间缩短（MD:−0.60,95% CI:−0.95 ~−0.24,p = 0.18, I²= 42%）。Harris髋关节评分（HHS）也较高（MD: 7.03, 95% CI: 4.81 ~ 9.26, p = 0.74, I²= 0%）。结论PFN联合外侧壁重建技术可增加失血量，减少愈合时间，改善功能预后，与单纯PFN或PFNA相比具有优势。普洛斯彼罗注册号：CRD42024602939。II级证据，II级研究的系统评价。

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$The role of lateral wall reconstruction in improving surgical outcomes for intertrochanteric femur fractures$

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The role of lateral wall reconstruction in improving surgical outcomes for intertrochanteric femur fractures

Purpose

Intertrochanteric fractures are the most common type of proximal femur fractures, with lateral wall fractures occurring in approximately 33% of cases. This meta-analysis compared the effectiveness of intramedullary fixation methods, specifically the proximal femoral nail (PFN) and the proximal femoral nail anti-rotation (PFNA), to other treatment options.

Methods

A systematic review was conducted using PubMed, Scopus, Web of Science and Embase, following PRISMA guidelines. We included clinical trials on intertrochanteric femur fractures with lateral wall involvement. Random effects models were used to analyze mean differences across treatment methods, with statistical evaluations including I², Cochran's Q, sensitivity analyses, and Egger's test. Additionally, a subgroup analysis was performed.

Results

Of the initial 1009 results, 10 studies involving 516 patients were included. The surgical methods assessed included PFN/PFNA, PFN with trochanteric buttress plates, screw-augmented PFN, PFNA with a sliding compression plate and InterTan. Blood loss was significantly greater in the experimental models (MD: 31.83, 95% confidence interval [CI]: 0.28–63.38, p < 0.001, I² = 99%). Union time was reduced in the experimental models (MD: −0.60, 95% CI: −0.95 to −0.24, p = 0.18, I² = 42%). The Harris hip score (HHS) was also higher (MD: 7.03, 95% CI: 4.81–9.26, p = 0.74, I² = 0%).

Conclusion

Combining PFN with lateral wall reconstruction techniques may increase blood loss, decrease union times, and improve functional outcomes, suggesting advantages over PFN or PFNA alone.