Dynamic hip screw combined with reduction fixation of lesser trochanter prevents hip coxa vara after intertrochanteric fractures：a meta-analysis / 中国组织工程研究

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 stil many reports about using dynamic hip screw to repair unstable intertrochanteric fractures, and the effect is obvious. However, there are stil 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 controled 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 controled 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 excelent and good rate of efficacy in the dynamic hip screw combined with lesser trochanter fixation group were al superior to those in the lesser trochanter unfixed group (alP < 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 (alP < 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 excelent 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.