Meta-analysis of the efficacy of medial femoral support plate combined with cannulated screws in the treatment of pauwels type III femoral neck fracture / 中国组织工程研究

ABSTRACT

BACKGROUND: In recent years, some scholars have proposed the use of medial femoral neck support plate combined with cannulated screw internal fixation to treat Pauwels type III femoral neck fracture. This method can reduce the incidence of complications such as nonunion of the femoral neck fracture and femoral head necrosis. However, it is still controversial whether this treatment can accelerate fracture healing and reduce femoral head necrosis in clinic. OBJECTIVE: Meta-analysis was performed to evaluate the difference in the efficacy of femoral medial support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation for the treatment of Pauwels type III femoral neck fracture. METHODS: Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search for and collect the clinical Chinese and English literature of the trials regarding Pauwels III femoral neck fracture treated with internal femoral support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation. Two evaluators independently conducted quality evaluation, data extraction and cross-checking of the included studies, and finally performed meta-analysis on the collected data using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) After screening, 5 related clinical trials were included, including 4 randomized controlled trials and 1 retrospective cohort study, for a total of 243 patients with Pauwels III femoral neck fracture. (2) Meta-analysis results showed that compared with simple cannulated internal fixation, operation time was longer [MD=23.19, 95%C/(8.32, 38.06), P=0.002], intraoperative blood loss was more [MD=83.48, 95%C/(32.08, 134.89), P=0.001], and healing time was shorter [MD=-1.56, 95%C/(-1.89, -1.24), P < 0.000 01], the incidence of complications was lower [RD=-0.07, 95%C/(-0.11, -0.02), P=0.003], and hip Harris score was higher [MD=7.39, 95%C/(3.18, 60), P=0.000 6] in the femoral medial support plate combined with cannulated screw internal fixation. However, there was no statistically significant difference in the excellent and good rate of hip function between the two treatments [OR=1.29, 95%C/(0.02, 74.86), P=0.90]. (3) In the treatment of Pauwels type III femoral neck fracture, compared with simple cannulated nail fixation, cannulated screws combined with medial support plate can shorten healing time, reduce postoperative complications and elevate postoperative Harris score.