Proximal Femoral Nails Anti-rotation, Gamma Nails and Dynamic Hip Screws in the Treatment of Intertrohanteric Fractures of Femur in Adults: A Systematic Review_West China Medical Journal

Authors：

MA Kunlong ¹ , WANG Xuan ² , LUAN Fujun ¹ , LIANG Yu ¹ , ZHANG Yingjie ² ,  FANG Yue ¹ , TU Chongqi ¹ , YANG Tianfu. ¹

1. Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China; 2. Medical College of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;

Corresponding author：

FANG Yue, Email: makunlong666@163.com

Keywords：

股骨转子间骨折; 股骨近端抗旋髓内钉; 动力髋螺钉; 伽马钉; 系统评价

DOI：

10.7507/1002-0179.20130113

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目的　评价股骨近端防旋髓内钉（PFNA）、动力髋螺钉（DHS）、伽马钉治疗股骨转子间骨折的有效性和安全性。方法　计算机检索Cochrane图书馆（2011年第12期），PubMed （1966年－2011年12月），EMBASE（1974年－2011年12月），web of science（1958年－2011年12月），万方数据库（1992年－2011年12月），维普资讯网（1989年－2011年12月），中国期刊全文数据库（1994年－2011年12月），中国生物医学文献数据库（1978年－2011年12月），纳入PFNA、DHS、伽马钉治疗股骨转子间骨折的随机前瞻性研究，采取修订后的Jadad评分量表对纳入研究进行质量评价。用RevMan 5.1软件进行Meta分析。结果　共纳入12个研究（1 477例患者）。Meta分析结果显示PFNA治疗股骨转子间骨折的手术时间[MD=−32.19，95%CI（−49.69，−14.69），P=0.000 3；MD=−4.52，95%CI（−5.24，−3.80），P＜0.000 01］，出血量[MD=−183.06，95%CI（−277.37，−88.74），P=0.000 1；MD=−49.49，95%CI（−84.15，−14.83），P=0.005]少于DHS组和伽马钉组，但是三者在总有效率、住院时间和术后并发症等方面差异无统计学意义。DHS组与伽马钉组在所有指标差异均无统计学意义。结论　与DHS、伽马钉相比，PFNA可明显缩短手术时间、降低术中出血量，但并不能提高总有效率、缩短住院时间以及减少术后并发症；而DHS与伽马钉治疗股骨转子间骨折的疗效无明显差异。

Citation： MA Kunlong,WANG Xuan,LUAN Fujun,LIANG Yu,ZHANG Yingjie,FANG Yue,TU Chongqi,YANG Tianfu.. Proximal Femoral Nails Anti-rotation, Gamma Nails and Dynamic Hip Screws in the Treatment of Intertrohanteric Fractures of Femur in Adults: A Systematic Review. West China Medical Journal, 2013, 28(3): 345-351. doi: 10.7507/1002-0179.20130113 Copy

1.	Zou J, Xu Y, Yang H. A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures[J]. J Int Med Res, 2009, 37(4): 1057-1064.
2.	Iqbal MM. Osteoporosis: epidemiology, diagnosis, and treatment[J]. South Med J, 2000, 93(1): 2-18.
3.	Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures[J]. Lancet, 2002, 359(9319): 1761-1767.
4.	Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies[J]. Instr Course Lect, 2004, 53: 441-454.
5.	刘海春, 陈允震, 杨子来, 等. 股骨粗隆间粉碎性骨折不同内固定疗效分析[J]. 中国骨与关节损伤杂志, 2005, 20(1): 18-20.
6.	Peyser A, Weil YA, Brocke L, et al. A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip[J]. J Bone Joint Surg Br, 2007, 89(9): 1210-1217.
7.	Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures[J]. Int Orthop, 2003, 27(1): 11-17.
8.	王强, 王静成, 蒋百川, 等. PFN与DHS治疗股骨转子间骨折的疗效分析[J]. 实用临床医药杂志, 2007, 11(11): 44-45.
9.	Dharmarajan TS, Banik P. Hip fracture. Risk factors, preoperative assessment, and postoperative management[J]. Postgrad Med, 2006, 119(1): 31-38.
10.	O’ Brien PJ, Meek RN, Blachut PA, et al. Fixation of intertrochanteric hip fractures Gamma nail versus dynamic hip screw.A randomised prospective study[J]. Can J Surg, 1995, 38(6): 516-520.
11.	曹烈虎, 刘欣伟, 苏佳灿, 等. 应用动力髋螺钉、Gamma钉与股骨近端髓内钉治疗高龄患者股骨转子间骨折:随机、前瞻设计95例随访分析[J]. 中国组织工程研究与临床康复, 2009, 13(17): 3342-3346.
12.	范震波, 李健, 赵洪普, 等. 高龄股骨粗隆间骨折手术治疗方法的疗效分析[J]. 国际医药卫生导报, 2009, 15(11): 24-28.
13.	陈海良, 庞瑞明, 刘红财, 等. PFNa治疗骨质疏松性股骨转子间骨折的临床观察[J]. 海南医学院学报, 2011, 17(4): 532-534.
14.	Bridle SH, Patel AD, Bircher M, et al. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw[J]. J Bone Joint Surg Br, 1991, 73(2): 330-334.
15.	杜浩, 郭锐, 张晓强, 等. Gamma钉与DHS微创治疗老年股骨转子间骨折的前瞻性研究[J]. 中华骨科杂志, 2008, 28(8): 638-641.
16.	Adams CI, Robinson CM, Court-Brown CM, et al. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur[J]. J Orthop Trauma, 2001, 15(6): 394-400.
17.	董华. 两种内固定方法治疗老年股骨转子问骨折的疗效比较[J]. 中国当代医药, 2011, 18(20): 170-171.
18.	Xu Y, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3[J]. Orthopedics, 2010, 33(7): 473.
19.	Verettas DA, Ifantidis P, Chatzipapas CN, et al. Systematic effects of surgical treatment of hip fractures: gliding screw-plating vs intramedullary nailing[J]. Injury, 2010, 41(3): 279-284.
20.	Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients[J]. J Bone Joint Surg Am, 1998, 80(5): 618-630.
21.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969, 51(4): 737-755.
22.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
23.	王春辉, 吴兵, 何方生, 等. 三种不同金属植入物内固定治疗老年股骨转子间骨折99例的随机对照[J]. 中国组织工程研究与临床康复, 2011, 15(39): 7323-7326.
24.	Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail[J]. J Bone Joint Surg Br, 2004, 86(1): 86-94.
25.	Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures?[J]. Clin Orthop Relat Res, 2005, 439(439): 221-227.
26.	Curtis MJ, Jinnah RH, Wilson V, et al. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation[J]. Injury, 1994, 25(2): 99-104.
27.	Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation[J]. Injury, 2006, 37(10): 984-989.
28.	Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study[J]. Injury, 2008, 39(8): 932-939.
29.	Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures[J]. Injury, 2009, 40(4): 428-432.
30.	Butt MS, Krikler SJ, Nafie S, et al. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial[J]. Injury, 1995, 26(9): 615-618.
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[J]. Int Orthop, 2009, 33(1): 255-260.
32.	Parker MJ, Pryor GA. Gamma versus DHS nailing for extracapsular femoral fractures. Meta-analysis of ten randomised trials[J]. Int Orthop, 1996, 20(3): 163-168.
33.	赵岩, 霍建军, 田禾, 等. 动力髋与Gamma钉治疗成人股骨粗隆间骨折疗效Meta分析[J]. 中国骨与关节损伤杂志, 2011, 26(8): 697-701.
34.	霍建军, 赵岩, 田禾, 等. Gamma钉与动力髋治疗老年股骨粗隆间骨折的系统评价[J]. 中国现代医学杂志, 2011, 21(7): 773-778.

1. 　Zou J, Xu Y, Yang H. A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures[J]. J Int Med Res, 2009, 37(4): 1057-1064.
2. 　Iqbal MM. Osteoporosis: epidemiology, diagnosis, and treatment[J]. South Med J, 2000, 93(1): 2-18.
3. 　Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures[J]. Lancet, 2002, 359(9319): 1761-1767.
4. 　Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies[J]. Instr Course Lect, 2004, 53: 441-454.
5. 　刘海春, 陈允震, 杨子来, 等. 股骨粗隆间粉碎性骨折不同内固定疗效分析[J]. 中国骨与关节损伤杂志, 2005, 20(1): 18-20.
6. 　Peyser A, Weil YA, Brocke L, et al. A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip[J]. J Bone Joint Surg Br, 2007, 89(9): 1210-1217.
7. 　Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures[J]. Int Orthop, 2003, 27(1): 11-17.
8. 　王强, 王静成, 蒋百川, 等. PFN与DHS治疗股骨转子间骨折的疗效分析[J]. 实用临床医药杂志, 2007, 11(11): 44-45.
9. 　Dharmarajan TS, Banik P. Hip fracture. Risk factors, preoperative assessment, and postoperative management[J]. Postgrad Med, 2006, 119(1): 31-38.
10. 　O’ Brien PJ, Meek RN, Blachut PA, et al. Fixation of intertrochanteric hip fractures Gamma nail versus dynamic hip screw.A randomised prospective study[J]. Can J Surg, 1995, 38(6): 516-520.
11. 　曹烈虎, 刘欣伟, 苏佳灿, 等. 应用动力髋螺钉、Gamma钉与股骨近端髓内钉治疗高龄患者股骨转子间骨折:随机、前瞻设计95例随访分析[J]. 中国组织工程研究与临床康复, 2009, 13(17): 3342-3346.
12. 　范震波, 李健, 赵洪普, 等. 高龄股骨粗隆间骨折手术治疗方法的疗效分析[J]. 国际医药卫生导报, 2009, 15(11): 24-28.
13. 　陈海良, 庞瑞明, 刘红财, 等. PFNa治疗骨质疏松性股骨转子间骨折的临床观察[J]. 海南医学院学报, 2011, 17(4): 532-534.
14. 　Bridle SH, Patel AD, Bircher M, et al. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw[J]. J Bone Joint Surg Br, 1991, 73(2): 330-334.
15. 　杜浩, 郭锐, 张晓强, 等. Gamma钉与DHS微创治疗老年股骨转子间骨折的前瞻性研究[J]. 中华骨科杂志, 2008, 28(8): 638-641.
16. 　Adams CI, Robinson CM, Court-Brown CM, et al. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur[J]. J Orthop Trauma, 2001, 15(6): 394-400.
17. 　董华. 两种内固定方法治疗老年股骨转子问骨折的疗效比较[J]. 中国当代医药, 2011, 18(20): 170-171.
18. 　Xu Y, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3[J]. Orthopedics, 2010, 33(7): 473.
19. 　Verettas DA, Ifantidis P, Chatzipapas CN, et al. Systematic effects of surgical treatment of hip fractures: gliding screw-plating vs intramedullary nailing[J]. Injury, 2010, 41(3): 279-284.
20. 　Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients[J]. J Bone Joint Surg Am, 1998, 80(5): 618-630.
21. 　Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969, 51(4): 737-755.
22. 　Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
23. 　王春辉, 吴兵, 何方生, 等. 三种不同金属植入物内固定治疗老年股骨转子间骨折99例的随机对照[J]. 中国组织工程研究与临床康复, 2011, 15(39): 7323-7326.
24. 　Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail[J]. J Bone Joint Surg Br, 2004, 86(1): 86-94.
25. 　Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures?[J]. Clin Orthop Relat Res, 2005, 439(439): 221-227.
26. 　Curtis MJ, Jinnah RH, Wilson V, et al. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation[J]. Injury, 1994, 25(2): 99-104.
27. 　Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation[J]. Injury, 2006, 37(10): 984-989.
28. 　Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study[J]. Injury, 2008, 39(8): 932-939.
29. 　Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures[J]. Injury, 2009, 40(4): 428-432.
30. 　Butt MS, Krikler SJ, Nafie S, et al. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial[J]. Injury, 1995, 26(9): 615-618.
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[J]. Int Orthop, 2009, 33(1): 255-260.
32. 　Parker MJ, Pryor GA. Gamma versus DHS nailing for extracapsular femoral fractures. Meta-analysis of ten randomised trials[J]. Int Orthop, 1996, 20(3): 163-168.
33. 　赵岩, 霍建军, 田禾, 等. 动力髋与Gamma钉治疗成人股骨粗隆间骨折疗效Meta分析[J]. 中国骨与关节损伤杂志, 2011, 26(8): 697-701.
34. 　霍建军, 赵岩, 田禾, 等. Gamma钉与动力髋治疗老年股骨粗隆间骨折的系统评价[J]. 中国现代医学杂志, 2011, 21(7): 773-778.

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Proximal Femoral Nails Anti-rotation, Gamma Nails and Dynamic Hip Screws in the Treatment of Intertrohanteric Fractures of Femur in Adults: A Systematic Review

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