Liang Mingzhou,Li Yang,Liu Xiaoyang.Efficacy of hollow screw versus locking compression hip plate for displaced pediatric femoral neck fracture:a Meta-analysis[J].Journal of Clinical Pediatric Surgery,2026,(06):558-566.[doi:10.3760/cma.j.cn101785-20260306-00091]
空心螺钉与髋部锁定加压接骨板治疗儿童移位型股骨颈骨折的Meta分析
- Title:
- Efficacy of hollow screw versus locking compression hip plate for displaced pediatric femoral neck fracture:a Meta-analysis
- Keywords:
- Femoral Neck Fractures; Fracture Fixation; Meta-Analysis
- 摘要:
- 目的 通过Meta分析系统评价空心螺钉与髋部锁定加压接骨板(locking compression pediatric hip plate,LCP-PHP)治疗儿童移位型股骨颈骨折的疗效。方法 检索中国知网、中国生物医学文献数据库、维普数据库、万方数据库、PubMed、Embase、Web of Science、Cochrane Library中关于空心螺钉与LCP-PHP治疗儿童移位型股骨颈骨折的相关文献,检索时间为自建库至2025年6月30日。文献纳入标准: ①年龄<18岁,诊断为移位型股骨颈骨折并手术; ②研究类型包括随机对照试验、前瞻性或回顾性队列研究、病例对照研究; ③干预措施为空心螺钉内固定与LCP-PHP内固定的比较; ④报告至少有1项本研究关注的结局指标。筛选后采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)进行质量评价,并提取数据,应用RevMan 5.4和Stata18.0进行Meta分析,比较两种手术方式的手术时间、切口直径、术中出血量、骨折愈合时间、骨折复位优良率、Harris功能评分、颈干角丢失情况、Ratliff分级优良率、术后总并发症发生率、术后股骨头坏死发生率、术后髋内翻发生率、术后骨骺早闭发生率。结果 共纳入9篇文献,其中中文文献8篇、英文文献1篇,均为回顾性队列研究,共531例儿童移位型股骨颈骨折病例,其中采取空心螺钉内固定317例(为空心螺钉组),LCP-PHP内固定 214例(为LCP-PHP组)。空心螺钉组手术时间(WMD=-21.26,95%CI:-36.92~-5.60,P=0.008)、切口直径(WMD=-2.77,95%CI:-3.12~-2.41,P＜0.00001)及术中出血量(WMD=-21.17,95%CI:-34.36~-7.99,P=0.002)优于LCP-PHP组。LCP-PHP组在Ratliff分级优良率(OR=0.32,95%CI:0.12~0.82,P=0.02)及颈干角丢失(WMD=1.54,95%CI:1.43~1.64,P＜0.00001)方面优于空心螺钉组。两组骨折愈合时间、骨折复位优良率、Harris功能评分、总并发症发生率以及股骨头坏死、髋内翻、骨骺早闭发生率差异无统计学意义(P>0.05)。结论 空心螺钉内固定治疗儿童移位型股骨颈骨折,相较LCP-PHP内固定具有手术时间短、切口直径小、术中出血量少的优势;而LCP-PHP内固定在远期髋关节功能恢复、防止颈干角丢失等方面较空心螺钉内固定效果更佳。
- Abstract:
- Objective To systematically evaluate the efficacy of hollow screws versus locking compression hip plate for displaced pediatric femoral neck fractures using meta-analysis. Methods The relevant literature published from database inception to July 30,2025,comparing cannulated screws with pediatric hip locking compression plate (LCP-PHP) for displaced pediatric femoral neck fractures was systematically searched across the following databases of China National Knowledge Infrastructure,Chinese Biomedical Literature Database,VIP,WANFANG,PubMed,Embase,Web of Science and Cochrane Library.Inclusion criteria:① age<18 years,diagnosed with displaced femoral neck fracture and operated; ② randomized controlled trials,cohort studies or case-control studies; ③ comparison between hollow screw fixation and LCP-PHP fixation; ④ reporting at least one outcome of interest in this study.After study selection,methodological quality of included articles was assessed using the Newcastle-Ottawa Scale (NOS).Data pertaining to outcome measures were extracted.Meta-analyses was performed using RevMan software (Version 5.4) and Stata (Version 18.0) for comparing outcomes between two intervention groups,including:operative duration,incision length,intraoperative volume of blood loss,fracture healing time,quality of fracture reduction (excellent/good rate),Harris Hip Score,neck-shaft angle loss,favorable rate based upon Ratliff criteria,overall complication rate,incidence of femoral head osteonecrosis,incidence of coxa vara and incidence of premature physeal closure. Results Among 9 studies,8 were published in Chinese and 1 in English,all being retrospective cohort studies.And 531 pediatric displaced femoral neck fracture cases (317 treated with cannulated screws,214 with LCP-PHP) were included.Meta-analysis revealed that cannulated screws had shorter operative duration (WMD=-21.26,95%CI:-36.92 to-5.60,P=0.008),smaller incision length (WMD=-2.77,95%CI:-3.12 to-2.41,P<0.00001) and less intraoperative volume of blood loss (WMD=-21.17,95%CI:-34.36 to-7.99,P=0.002) versus LCP-PHP.Conversely,LCP-PHP demonstrated a higher Ratliff excellent/good rate (OR=0.32,95%CI:0.12 to 0.82,P=0.02) and less loss of neck-shaft angle (WMD=1.54,95%CI:1.43 to 1.64,P<0.00001).No significant differences existed in fracture healing time,excellent/good fracture reduction rate,Harris hip scores,total complications,femoral head necrosis,coxa vara or premature physeal closure between two fixation modes (P>0.05). Conclusion For displaced pediatric femoral neck fractures,cannulated screws offer advantages in shorter operative duration,minimal incision and less volume of blood loss while LCP-PHP demonstrates superior long-term hip function outcomes and lower neck-shaft angle loss.
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备注/Memo
收稿日期:2026-3-6。
通讯作者:刘潇阳,Email:202335848@mail.sdu.edu.cn