中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (35): 5724-5729.doi: 10.3969/j.issn.2095-4344.1020

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

中青年股骨颈骨折术后内固定物去留与股骨头坏死关系的Meta分析

周 新，杨彦飞，牛文杰，卫小春，段王平   

  1. 山西医科大学第二医院骨科，骨与软组织损伤修复山西省重点实验室，山西省太原市 030001
  • 通讯作者: 段王平，博士，副教授，硕士生导师，山西医科大学第二医院骨科，骨与软组织损伤修复山西省重点实验室，山西省太原市 030001
  • 作者简介:周新，男，1990年生，河北省黄骅市人，汉族，山西医科大学第二医院骨科在读硕士，主要从事关节外科方面的研究。
  • 基金资助:

    国家自然科学基金青年科学基金项目(81601949)；国家国际科技合作专项项目(2015DFA33050)；山西省科技基础条件平台项目(201705D121010)

Relationship between internal fixation removal and femoral head necrosis after femoral neck fracture in young and middle-aged patients: a meta-analysis

Zhou Xin, Yang Yanfei, Niu Wenjie, Wei Xiaochun, Duan Wangping   

  1. Department of Orthopedics, the Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030001, Shanxi Province, China
  • Contact: Duan Wangping, MD, Associate professor, Master’s supervisor, Department of Orthopedics, the Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030001, Shanxi Province, China
  • About author:Zhou Xin, Master candidate, Department of Orthopedics, the Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan 030001, Shanxi Province, China
  • Supported by:

    the Youth National Natural Science Foundation of China, No. 81601949; the National Internal Science and Technology Cooperation Project of China, No. 2015DFA33050; the Science & Technology Infrastructure Project of Shanxi Province, No. 201705D121010

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摘要：

文章快速阅读：

 
 
 

 

文题释义：
股骨颈骨折：是自股骨头以下至股骨颈基底部的骨折，是临床上常见的疾病之一，中青年股骨颈骨折主要由高能量损伤所致，目前主要采用闭合复位空心钉治疗，老年股骨颈骨折患者多采用髋关节置换术治疗。
股骨头坏死：是由于不同的病因所引起的股骨头血供破坏而导致软骨下骨变性甚至坏死，继而导致股骨头的塌陷，最终引起髋关节退行性破坏性变化，其主要与股骨颈的血液供应、生物力学等因素有关。
 
摘要
背景：目前临床上对于中青年股骨颈骨折患者主要采取闭合复位空心钉治疗，骨折愈合后关于空心钉的处理尚存在争议。
目的：探讨股骨颈骨折术后内固定物的取出和保留与股骨头坏死的关系，为中青年股骨颈骨折术后内固定物的处理提供参考。
方法：利用检索EMBASE、Cochrane数据库、PubMed数据库、万方数据库、CNKI中国期刊全文数据库，并辅助手工检索、文献追溯相关文献，收集2000年1月至2018年1月国内外刊物上公开发表的有关股骨颈骨折术后内固定物是否取出对股骨头坏死影响的中英文文献，严格评价纳入研究的文献质量及提取相关资料，运用RevMan 5.3软件统计分析相关数据。对相关数据进行异质性检验，用Meta分析方法对数据进行处理，评估其比值比(OR)和95%可信区间(CI)。
结果与结论：①通过检索词共检索出中英文文献418篇，最终共纳入满足条件的文献20篇，共6 271例患者；②随机效应模型分析结果显示，与内固定保留组相比，股骨颈骨折术后内固定取出组股骨头坏死率更高，差异有显著性意义[OR=2.49，95%CI (1.47，4.22)，P=0.000 7]；③共3篇文献提及股骨颈骨折术后内固定物是否取出对股骨头血运的影响。其中1篇文献认为股骨颈骨折术后骨愈合后取钉会破坏股骨头的血运，不利于股骨头的重建修复；另外2篇文献认为骨折术后间断取钉能改善股骨头血运；④有文献认为股骨颈骨折术后骨愈合后是否取钉对股骨头最大压应力无明显变化，但内固定物长期存留在体内会增加患者局部滑囊炎的发生，影响患肢功能；⑤结果提示，中青年股骨颈骨折术后骨愈合后，与内固定物保留相比，内固定物取出更容易破坏股骨头血运，导致股骨头坏死，临床上应积极探索中青年股骨颈骨折术后内固定的取出方式及防治股骨头坏死的相关措施。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-2525-5945(周新)

关键词: 股骨颈骨折, 股骨头坏死, 内固定物, 内植物, 取出, Meta分析, 国家自然科学基金

Abstract:

BACKGROUND: Femoral neck fracture in young and middle-aged patients is mainly treated with closed reduction cannulated screws. However, how to deal with the cannulated screws after fracture healing remains unclear.

OBJECTIVE: To explore the association of implant removal or retention with femoral head necrosis, and to provide reference for the management of implant after femoral neck fracture in young and middle-aged patients.
METHODS: The English studies addressing implant removal or not effects on the femoral head necrosis after femoral neck fracture in the EMBASE, Cochrane Library, PubMed, WanFang, and CNKI databases were retrieved and from January 2000 to January 2018. Methodological quality of the trials was assessed, relevant data were extracted, and heterogeneity test was performed. A meta-analysis was conducted to calculate the OR value and 95%CI.
RESULTS AND CONCLUSION: (1) A total of 418 articles were searched and 20 eligible studies involving 6 271 patients were included. (2) The random effect model result showed that compared with implant maintenance, implant removal was more likely to cause femoral head necrosis (OR=2.49, 95%CI (1.47, 4.22), P=0.000 7). (3) Three articles mentioned the effect of implant removal on femoral head blood supply after femoral neck fracture. One article suggested that removing the implant after fracture healing would destroy the blood supply of the femoral head, doming harm to the reconstruction of the femoral head. Two articles considered that discontinuously removing the implant could improve femoral head blood supply. (4) The maximum compressive stress of the femoral head showed no significant change when the nail removal after fracture healing. However, the long-term presence of implant would increase the incidence of local bursitis and affect the function of injured limbs. (5) These results indicate that compared with the implant maintenance, implant removal is more likely to destroy the blood supply and induce femoral head necrosis. We should actively explore the removal method of the implant in young and middle-aged patients after femoral neck fracture to prevent femoral head necrosis. 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Fractures, Femur Head Necrosis, Meta-Analysis, Tissue Engineering

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