Network Meta-analysis of postoperative complications incidence of different internal fixation methods in the treatment of Pauwels type Ⅲ femoral neck fracture
Objective:To evaluate the postoperative complication rate of Pauwels type Ⅲ femoral neck fracture treated by different internal fixation modalities using network Meta-analysis.Methods:Randomized controlled trials and cohort studies on internal fixation for Pauwels type Ⅲ femoral neck fracture were searched in PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang,VIP,and SinoMed databases.The literature of the search results included traditional 3 cannulated screws,3 cannulated screws combined with medial buttress plate,dynamic hip screw combine with anti-rotation screw,femoral neck system,4 cannulated screws in diamond distribution,3 cannulated screws in"F"type distribution,3 cannulated screws combined with a transverse cannulated screw and transverse cancellous bone lag screw.Postoperative femoral head necrosis rate and fracture non-union rate as observational indicators,and Meta-analysis was performed using Stata 17.0 software.Results:A total of 43 articles were included,comprising 12 randomized controlled trials and 31 retrospective cohort studies,with totaling 2 778 patients.The results of Meta-analysis suggested that compared with the traditional 3 cannulated screws,3 cannulated screws combined with medial buttress plate and 3 cannulated screws in"F"type distribution could reduce the postoperative femoral head necrosis(P<0.05).The internal fixation of 3 cannulated screws combined with medial buttress plate,4 cannulated screws in diamond distribution and 3 cannulated screws combined with a transverse cannulated screws could reduce the incidence of fracture non-union,the results were statistically significant(P<0.05).The results of the network Meta-analysis indicated that the top two different internal fixation modalities in order of superiority to inferiority in postoperative femoral head necrosis rate were 4 cannulated screws in diamond distribution(79.5％)and femoral neck system(68.3％).The top two rankings of different internal fixation modalities in terms of the incidence of postoperative fracture non-union were 4 cannulated screws in diamond distribution(73.9％)and 3 cannulated screws combined with a transverse cannulated screw(69.7％).Conclusion:Among the eight internal fixation modalities,4 cannulated screws in diamond distribution was optimal in ranking the incidence of necrosis of the femoral head and fracture non-union after Pauwels type Ⅲ femoral neck fracture,suggesting that it may be the optimal choice for the clinical treatment of Pauwels type Ⅲ femoral neck fracture,but it still needs to be further confirmed by more large-sample,multicentre,double-blind randomized controlled trial studies.
net work Meta-analysismedia buttress platecannulated screwfemoral neck fracturerandomized controlled trial
NETL
NSTL
维普
万方数据
