Dynamic hip screw combined with reduction fixation of lesser trochanter prevents hip coxa vara after intertrochanteric fractures: a meta-analysis

doi:10.3969/j.issn.2095-4344.2015.31.027

Abstract

Abstract:

BACKGROUND: More and more elderly patients have hip fractures because of diverse reasons, and most of the fractures are unstable fractures combined with the displacement of the lesser trochanter. At present, there are still many reports about using dynamic hip screw to repair unstable intertrochanteric fractures, and the effect is obvious. However, there are still great controversies regarding whether lesser trochanter fixation is performed during the repair process.
OBJECTIVE: To evaluate the effect of using dynamic hip screw combined with the lesser trochanter fixation to repair intertrochanteric fractures and the occurrence of hip coxa vara after repair through a meta-analysis.
METHODS: The PubMed, EMCC, CBM, CNKI, VIP and Wanfang databases were retrieved by computer for randomized controlled trials on whether lesser trochanter reduction fixation was performed during the process of dynamic hip screw internal fixation for repair of intertrochanteric fractures. The quality of the included studies was evaluated according to the pre-designated inclusion and exclusion criteria. The available data were extracted and
analyzed using the RevMan5.2 software.
RESULTS AND CONCLUSION: A total of 10 randomized controlled trials involving 604 patients were included. Among them, 298 cases were assigned to the dynamic hip screw combined with lesser trochanter fixation group, and 306 cases to the lesser trochanter unfixed group. The meta-analysis results indicated that hip coxa vara, other postoperative complications, the excellent and good rate of efficacy in the dynamic hip screw combined with lesser trochanter fixation group were all superior to those in the lesser trochanter unfixed group (all P < 0.000 1), and for hip coxa vara, the parameters were odds ratio=0.17, 95% confidence interval (0.07, 0.41), Z=3.99, P < 0.000 1. The operation time and the amount of blood loss in the lesser trochanter unfixed group were superior to those in the dynamic hip screw combined with lesser trochanter fixation group (all P < 0.000 1). These results suggest that the lesser trochanter unfixed therapy has the advantages of relatively simple operation, shorter operative time and less blood loss during the process of dynamic hip screw internal fixation for repair of unstable intertrochanteric fractures. However, the excellent and good rates of efficacy, hip coxa vara and other postoperative complications were superior in patients with intertrochanteric fracture above the Tronzo-Evans III type who received dynamic hip screw combined with lesser trochanter fixation to those who received lesser trochanter unfixed therapy. The results indicate that dynamic hip screw combined with lesser trochanter fixation for repair of intertrochanteric fracture is beneficial to prevent hip coxa vara and other complications.

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, Internal Fixators, Meta Analysis, Evidence-Based Medicine

CLC Number:

R318

Lin Zhen-hua, He Jia-nan, Liu Xing-mo. Dynamic hip screw combined with reduction fixation of lesser trochanter prevents hip coxa vara after intertrochanteric fractures: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(31): 5065-5071.

Figures/Tables 7

References

[1] 吴在德.外科学[M]. 5版.北京:人民卫生出版社,2002:871.
[2] Laohapoonrungsee A, Arpornchayanon O, Phornputkul C.Two-hole side-plate DHS in the treatment of intertrochanteric fracture: results and complications. Injury. 2005;36(11):1355-1360.
[3] Lin PC, Chang SY. Functional recovery among elderly people one year after hip fracture surgery. J Nurs Res. 2004;12(1): 72-82.
[4] Desai SJ, Patel J, Abdo H, et al. A comparison of surgical delays in directly admitted versus transferred patients with hip fractures:opportunities for improvement? Can J Surg. 2014; 57(1):40-43.
[5] Lorieh DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric Hip fractures: management and current controversies. Instr Course Lect.2004;53(5): 441-454.
[6] 贺亮. DHS治疗不稳定型股骨粗隆间骨折中小粗隆复位固定的临床研究[D].福建中医学院,2008.
[7] 朱磊. DHS治疗不稳定型股骨转子间骨折中复位固定小转子的临床研究[D].安徽医科大学,2010.
[8] 阮文礼,曲俊才.不同方法处置股骨小转子在DHS治疗股骨粗隆间骨折中的比较研究[J]. 中国中医骨伤科杂志,2011,19(11): 41-42.
[9] 黄劲东,陈桂华.不稳定型股骨粗隆间骨折治疗中小粗隆骨折的处理[J]. 医学理论与实践,2013,26(20):2722-2723.
[10] 肖永志,杭志刚,刘艳华.粗隆间骨折的后内侧骨皮质连续性重建方法及意义[J].中国矫形外科杂志,2006,14(20):1589-1591.
[11] 崔洪宇.动力髋螺钉配合中药治疗不稳定型股骨粗隆间骨折[D].黑龙江中医药大学,2011.
[12] 方华,黄杰,陈丰,等.动力髋螺钉治疗不稳定股骨转子间骨折:两种方法处理内侧弓的比较[J].临床骨科杂志,2010,13(2): 157-159.
[13] 王兆杰,安荣泽,齐新文,等.小转子复位固定在股骨转子间骨折治疗中的临床意义[J].中国矫形外科杂志,2009,17(4):312-313.
[14] 姜劲松,王秀峰,程俊文,等.转子间粉碎骨折治疗中小转子复位固定的临床意义[J].实用医技杂志,2010,17(4):365-366.
[15] 王国胜,曹力.股骨转子间粉碎骨折小转子复位与未复位对发生髋内翻影响的临床研究[J].新疆医科大学学报,2014,37(2): 195-198.
[16] Sadowski C, Lubbeke A, Saudan M, et al. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg(Am). 2002;84(3):372-381.
[17] Felix B, Henry Z, Christoph L, et al. Treatment strategies for proximal femur fractures in osteoporotic patients. Osteoporos Int. 2005;16(2):93-102.
[18] Takigami I, Matsumoto K, Ohara A,et al. Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system-report of early results. Bull NYU Hosp Jt Dis. 2008;66(4):276-279.
[19] 马洪良,彭军,陈懿.解剖型钢板与动力髋螺钉治疗股骨转子间骨折的Meta分析[J].中国组织工程研究,2013,17(43): 7602-7609.
[20] Alobaid A, Harvey EJ, Elder GM,et al. Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device.J Orthop Trauma. 2004;18(4):207-212.
[21] 刘沂. AO内固定技术[J].北京医学,1991,27(6):366-369.
[22] Zhang Q, Chen W, Liu HJ, et al. The role of the calcar femorale in stress distribution in the proximal femur. Orthop Surg. 2009;1(4):311-316..
[23] Stiehl JB, Jacobson D, Carrera G. Morphological analysis of the proximal femur using quantitative computed tomography. Int Orthop. 2007;31(3):287-292.
[24] 黄梦全.有限元法分析后内侧骨折对近端股骨的力学影响[D].南方医科大学,2010.
[25] Kuzyk PR, Lobo J, Whelan D, et al. Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures. J Orthop Trauma. 2009;23(1):31-38.
[26] 陈红卫,王子阳,赵品益,等.动力髋螺钉治疗股骨粗隆间骨折并发症原因分析及防治[J].实用骨科杂志,2005,11(5):404-405.
[27] Otsuka NY, Schatzker J. Subcapital fracture of the hip after internal fixation of an intertrochanteric fracture. A case report. Arch Orthop Trauma Surg. 1993;112(2): 69-70.
[28] 黄聚恩,王海景,马高峰,等.滑动加压鹅头钉治疗股骨粗隆间骨折56 例报告[J].中国矫形外科杂志,2000,7(10):1023-1025．
[29] 罗从风,朱越,王磊,等. 459例动力髋螺钉治疗股骨粗隆周围骨折结果分析[J].中华创伤骨科杂志,2002,4(3):188-191．
[30] 王兆杰,安荣泽,齐新文,等.小转子复位固定在股骨转子间骨折治疗中的临床意义[J].中国矫形外科杂志,2009,17(4):312-313．
[31] Saarenpää I, Heikkinen T, Ristiniemi J, et al. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients. Int Orthop.2009;33(1):255-260.
[32] Li H, Zhang Y. [Research advance of dynamic hip screw internal fixation in treatment of intertrochanteric fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005; 19(10): 839-842.
[33] Audige L, Hanson B, Swiontkowski MF. Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-p late versus dynamic screw- intramedullary nail devices. Int Orthop. 2003;4: 197-203.
[34] Haynes RC, Poll RG, Miles AW, et al. Failure of femoral head fixation: a cadaveric analysis of lag screw cut-out with the gamma locking nail and AO dynamic hip screw. Injury.1997; 5-6: 337-341.
[35] Wu MH, Lee PC, Peng KT, et al. Complications of cement-augmented dynamic hip screws in unstable type intertrochanteric fractures--a case series study. Chang Gung Med J. 2012;35(4):345-353.
[36] Apel DM, Patwardhan A, Pinzur MS, et al. Axial loading studies of unstable intertrochanteric fractures of the femur. Clin Orthop Relat Res. 1989;246:156-164.
[37] Harrington KD, Johnston JO. The management of comminuted unstable intertrochanteric fractures. J Bone Joint Surg Am. 1973;55(7):1367-1376.
[38] Do JH, Kim YS, Lee SJ, et al. Influence of fragment volume on stability of 3-part intertrochanteric fracture of the femur: a biomechanical study. Eur J Orthop Surg Traumatol. 2013; 23(4):371-377.
[39] Kim WY, Han CH, Park JI, et al. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25(6):360-362.
[40] Taeger G, Schmid C, Zettl R, et al. [Stable and unstable pertrochanteric femoral fractures. Differentiated indications for the dynamic hip screw]. Unfallchirurg. 2000;103(9): 741-748.