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Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures

  1. Martyn J Parker*,
  2. Abhijit Banerjee

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 20 APR 2005

Assessed as up-to-date: 17 FEB 2005

DOI: 10.1002/14651858.CD001705.pub2


How to Cite

Parker MJ, Banerjee A. Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001705. DOI: 10.1002/14651858.CD001705.pub2.

Author Information

  1. Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough, Cambridgeshire, UK

*Martyn J Parker, Orthopaedic Department, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, PE3 6DA, UK. martyn.parker@pbh-tr.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

In the fixation of intracapsular hip fractures, different implants, surgical approaches and ancillary manoeuvres have been employed to improve the reduction, and the stability of the reconstruction, in an attempt to reduce the frequency of non-union and aseptic necrosis of the femoral head.

Objectives

To compare alternative surgical approaches and ancillary techniques in internal fixation of intracapsular hip fractures which have been subjected to randomised and quasi-randomised trials in adults.

Search methods

The Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, MEDLINE, and reference lists of relevant articles were searched. Date of the most recent search: November 2004.

Selection criteria

All randomised and quasi-randomised trials investigating operative technique for the treatment of intracapsular hip fractures.

Data collection and analysis

Two authors independently assessed trial quality, by use of a 10 item checklist, and extracted data.

Main results

One trial with 103 participants studied the effect of impaction of the fracture at the time of surgery. The only outcome measure reported was bone scintimetry. There was some evidence that impaction, particularly of displaced fractures, resulted in a reduction of blood flow to the femoral head as assessed by bone scintimetry.

One quasi-randomised trial with 220 participants compared compression of the fracture with no compression. Results for 156 individuals at one year showed a tendency to a lower incidence of non-union for those fractures treated without compression.

Two trials, one involving 102 young adults under 50 years old and the other involving 49 older people aged 65 years or over, compared open versus closed reduction of the fracture. Both found open reduction significantly increased length of surgery. None of the other differences between open and closed reduction in the outcomes reported by the two trials were statistically significant.

Authors' conclusions

Insufficient evidence exists from randomised trials to confirm the relative effects of open versus closed reduction of intracapsular fractures, or the effects of intra-operative impaction or compression of an intracapsular fracture treated by internal fixation.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Not enough evidence to show which surgical technique is preferable for internal fixation of intracapsular hip fractures

Hip fractures located within the hip joint capsule (intracapsular hip fractures) may be surgically fixed using a variety of different implants and surgical techniques. This review examines the effects of different surgical techniques. It found insufficient evidence from randomised trials to assess the effects of compression or of impaction of the fracture during surgery. It found limited evidence that open reduction (surgically exposed) as compared with closed reduction (under X-ray control) resulted in a greater length of surgery. The lack of evidence showing benefit of open reduction supports the use of closed reduction of these fractures.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用於治療關節囊內近端股骨骨折之內固定手術所使用之外科手術法及輔助技巧

在髖骨關節囊內骨折之固定技術中,不同植入物、外科技術與輔助性的技巧等皆被用來增進復位以及重建關節後的穩定性,及降低術後無法癒合和股骨頭無菌性壞死的頻率。

目標

比較用於成年人身上之髖骨囊內骨折內固定術所可使用的外科手術法與輔助物的技術,我們使用了會受到其影響的隨機與半隨機試驗來做測試。

搜尋策略

搜尋了The Cochrane Musculoskeletal Injuries Group Specialised Register, MEDLINE,以及相關文章的參考文獻清單。目前的搜尋大多數於2004年11月進行。

選擇標準

所有的隨機及半隨機試驗皆被用來偵測治療髖骨囊內骨折之手術技巧。

資料收集與分析

兩位作者獨立地使用十個項目量表來檢視試驗品質並擷取數據。

主要結論

一項有103位參與者的試驗研究了進行手術時骨折所帶來的影響。唯一被使用於測量結果的儀器為骨閃爍照影。由骨閃爍照影所顯示的證據指出,特別是發生在移位性骨折身上的壓迫效果會導致運送至股骨頭的血流減少。一個共有220人參與的半隨機試驗比較了在手術時有無將骨折處壓迫所造成的影響。共有156位患者在術後一年追蹤時發現,未將骨折處壓迫的骨折傾向於骨頭之間發生不癒合的情形比較少。一項包括了102位五十歲以下年輕人的試驗以及另一項包括了49位六十五歲以上老年人的試驗,兩項試驗比較了侵入式及非侵入式骨折錯位後復位之間的不同。兩個試驗皆認為侵入式的骨折錯位後復位顯著地增加了手術時間。在這兩個試驗中並無發現其它在侵入式及非侵入式骨折錯位後復位後的結果有任何數據上顯著的不同。

作者結論

從隨機試驗的結果中,目前尚無足夠的證據能夠確定侵入式及非侵入式之囊內骨折錯位後復位所能夠帶來的相對療效,或者是使用內固定術來治療囊內骨折時所使用的壓迫術之療效。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前沒有足夠的證據顯示哪一個手術技巧用來固定髖骨囊內骨折的結果較好。髖骨骨折若發生在髖關節囊內中(即髖關節囊內骨折),可能會以許多不同的植入物或手術技巧來在手術中做治療。本篇文獻回顧主要在檢測不同外科手術技巧所帶來的療效。但在隨機試驗中並沒有發現足夠的證據來評估使用壓迫術或在手術時對骨折處加壓的療效。僅發現非常有限的證據能夠證明侵入式(使用外科手術)骨折錯位後復位比起非侵入式(使用X光控制)來說會導致手術時間的延長。因為缺少了証明開放式骨折復位較佳的證據,因此支持了在這些骨折後使用閉鎖式復位較佳的論點。