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[1]鄺孝坤,田可為,范克杰,等.股骨頸骨折空心螺釘內固定術后股骨頸短縮危險因素的Meta分析[J].中醫(yī)正骨,2024,36(10):44-51.
　KUANG Xiaokun,TIAN Kewei,FAN Kejie,et al.Risk factors for femoral neck shortening after hollow screw internal fixation for femoral neck fracture:a meta analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(10):44-51.
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股骨頸骨折空心螺釘內固定術后股骨頸短縮危險因素的Meta分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年10期
頁碼:
44-51
欄目:
文獻研究
出版日期:
2024-10-20

文章信息/Info

Title:
Risk factors for femoral neck shortening after hollow screw internal fixation for femoral neck fracture:a meta analysis
作者:
鄺孝坤1; 田可為2; 范克杰2; 馬文龍2; 劉英科1; 嚴嘉祥2; 王敬威2; 田燃2; 栗林1; 陳柯2
1.河南中醫(yī)藥大學研究生院,河南 鄭州 450046; 2.河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002
Author(s):
KUANG Xiaokun1; TIAN Kewei2; FAN Kejie2; MA Wenlong2; LIU Yingke1; YAN Jiaxiang2; WANG Jingwei2; TIAN Ran2; LI Lin1; CHEN Ke2
1.Postgraduate College of Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China 2.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關鍵詞:
股骨頸骨折;  骨折固定術; 內;  骨螺絲;  股骨頸短縮;  危險因素;  專題Meta分析
Keywords:
femoral neck fractures;  fracture fixation; internal;  bone screws;  femoral neck shortening;  risk factors;  meta-analysis as topic
摘要:
目的:系統(tǒng)評價股骨頸骨折(femoral neck fracture,FNF)空心螺釘內固定術后股骨頸短縮(femoral neck shortening,FNS)的危險因素。方法:檢索中國知網(wǎng)、中國生物醫(yī)學文獻服務系統(tǒng)、萬方數(shù)據(jù)庫、維普網(wǎng)、PubMed、Cochrane Library、Embase、Web of Science,搜集有關FNF空心螺釘內固定術后FNS危險因素的隊列研究或病例對照研究,檢索時限均為建庫至2024年3月1日。由2名研究人員獨立篩選文獻、提取數(shù)據(jù)并評價納入研究的偏倚風險后,采用Stata16.0軟件進行Meta分析。結果:共納入16項研究,均為病例對照研究,共涉及1583例FNF患者。Meta分析結果顯示,年齡[MD=3.10,95%CI(0.36,5.84),P=0.026]、骨質疏松[OR=3.44,95%CI(2.50,4.75),P=0.000]、Singh指數(shù)Ⅳ～Ⅵ級[OR=1.57,95%CI(1.11,2.23),P=0.011]、GardenⅢ～Ⅳ型[OR=3.65,95%CI(1.95,6.85),P=0.000]、PauwelsⅢ型[OR=5.01,95%CI(2.98,8.43),P=0.000]、切開復位[OR=3.29,95%CI(1.69,6.42),P=0.000]、Garden指數(shù)Ⅲ～Ⅳ級[OR=5.15,95%CI(3.94,6.74),P=0.000]均為FNF空心螺釘內固定術后FNS的危險因素; 性別、高血壓病史、糖尿病病史、置釘方式、住院時間與FNS的關聯(lián)性均無統(tǒng)計學意義。體質量指數(shù)按照數(shù)據(jù)類型進行亞組分析,二分類變量組(≤24 kg·m-2/>24 kg·m-2)的分析結果顯示,體質量指數(shù)>24 kg·m-2是FNS的危險因素[OR=3.32,95%CI(2.19,5.03),P=0.000]; 連續(xù)性變量組的分析結果顯示,體質量指數(shù)與FNS的關聯(lián)性無統(tǒng)計學意義。受傷至手術時間按照時間劃分的界值進行亞組分析,24 h界值組(≤24 h/>24 h)的分析結果顯示,受傷至手術時間與FNS的關聯(lián)性無統(tǒng)計學意義; 4 d界值組(≤4 d/>4 d)的分析結果顯示,受傷至手術時間>4 d是FNS的危險因素[OR=2.04,95%CI(1.46,2.86),P=0.000]。完全負重時間按照時間劃分的界值進行亞組分析,2個月界值組(≤2個月/>2個月)的分析結果顯示,術后2個月內完全負重是FNS的危險因素[OR=2.57,95%CI(1.03,6.38),P=0.000]; 3個月界值組(≤3個月/>3個月)的分析結果顯示,完全負重時間與FNS的關聯(lián)性無統(tǒng)計學意義。分別采用固定效應模型和隨機效應模型對上述指標進行Meta分析,所得結果接近,表明研究結果穩(wěn)健可靠。基于Garden分型進行發(fā)表偏倚分析,Egger's檢驗結果提示不存在發(fā)表偏倚(P=0.190)。結論:現(xiàn)有證據(jù)表明,年齡、骨質疏松、Singh指數(shù)Ⅳ～Ⅵ級、GardenⅢ～Ⅳ型、PauwelsⅢ型、切開復位、Garden指數(shù)Ⅲ～Ⅳ級是FNF空心螺釘內固定術后FNS的危險因素,體質量指數(shù)、受傷至手術時間、完全負重時間與FNS的關系尚不明確。
Abstract:
Objective:To systematically review the risk factors for femoral neck shortening(FNS)after internal fixation with hollow screw for treating femoral neck fracture(FNF).Methods:All the cohort study articles and case-control study articles about the risk factors for FNS after internal fixation with hollow screw for FNF included from database's inception to March 1,2024 were retrieved from the China National Knowledge Infrastructure,Chinese Biomedical Literature Service System,Wanfang Database,Vip Database,PubMed,Cochrane Library,Embase and Web of Science.The pertinent articles were screened,the information was extracted and the risk of bias of the included researches was assessed independently by two researchers,and then a Meta-analysis was conducted by using Stata16.0 software.Results:Sixteen case-control study articles were included in the final analysis,involving 1583 FNF patients.The results of Meta-analysis revealed that the age(MD=3.10,95%CI(0.36,5.84),P=0.026),osteoporosis(OR=3.44,95%CI(2.50,4.75),P=0.000),Singh's index graded from Ⅳ to Ⅵ(OR=1.57,95%CI(1.11,2.23),P=0.011),Garden type Ⅲ-Ⅳ(OR=3.65,95%CI(1.95,6.85),P=0.000),Pauwels type Ⅲ(OR=5.01,95%CI(2.98,8.43),P=0.000),open reduction(OR=3.29,95%CI(1.69,6.42),P=0.000),Garden's index graded from Ⅲ to Ⅳ(OR=5.15,95%CI(3.94,6.74),P=0.000)were the risk factors for FNS in patients who underwent hollow screw internal fixation for FNF; while,the associations of gender,hypertension history,diabetes mellitus history,screw placement method,and hospital stays with FNS were not statistical significant.A subgroup analysis on body mass index(BMI)was conducted according to the data type,and the results of binary variable group(BMI≤24 kg/m(2)or >24 kg/m(2))showed that a BMI greater than 24 kg/m(2)was the risk factor for FNS(OR=3.32,95%CI(2.19,5.03),P=0.000); while the results of continuous variable group indicated that the association between BMI and FNS was not statistical significant.Additionally,a subgroup analysis on time from injury to surgery was performed according to the cut-off value defined by time,and the results of 24-hour cut-off value group(time from injury to surgery≤24 hours or >24 hours)indicated that the association between time from injury to surgery and FNS was not statistical significant; while the results of 4-day cut-off value group(time from injury to surgery≤4 days or >4 days)suggested that the time from injury to surgery over 4 days was a risk factor for FNS(OR=2.04,95%CI(1.46,2.86),P=0.000).Moreover,a subgroup analysis on full weight-bearing walking start time was performed according to the cut-off value defined by time,and the results of 2-month cut-off value group(full weight-bearing walking start time≤2 months or >2 months)revealed that full weight-bearing within 2 months after surgery was a risk factor for FNS(OR=2.57,95%CI(1.03,6.38),P=0.000); while the results of 3-month cut-off value group(full weight-bearing walking start time≤3 months or >3 months)suggested that the association between full weight-bearing walking start time and FNS was not statistical significant.The Meta-analysis was performed on the aforementioned indicators by employing a fixed-effect model and a random-effect model,respectively,and the results showcased that no evident change was found in the result of each indicator,suggesting the findings of the Meta-analysis in this study were relatively stable and reliable.Moreover,the publication bias was analyzed based on the Garden typing,and the result of Egger's test showed that there was no publication bias in the included articles(P=0.190).Conclusion:Available evidences suggest that the age,osteoporosis,Singh's index graded from Ⅳ to Ⅵ,Garden type Ⅲ-Ⅳ,Pauwels type Ⅲ,open reduction,Garden's index graded from Ⅲ to Ⅳ are the risk factors for FNS after internal fixation with hollow screw for FNF; while,the relation of BMI,time from injury to surgery and full weight-bearing walking start time to FNS are not yet clear.

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備注/Memo

備注/Memo:
基金項目:河南省重點研發(fā)與推廣專項項目(182102310467); 河南省醫(yī)學科技攻關計劃項目(LHGJ20230483); 河南省中醫(yī)藥科學研究專項課題(20-21ZY2253,20-21ZY2238)
通訊作者:陳柯 E-mail:[email protected]
更新日期/Last Update: 1900-01-01