Abstract
ObjectiveTo compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture.MethodsThe search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups.ResultsA total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time.ConclusionCompared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture.Study registration PROSPERO registration number CRD42020214493.
Highlights
The femoral neck fracture is the most common hip fracture, which often occurs in elderly patients with osteoporosis, and it accounts for 3.58% and 54% of systemic fractures and hip fractures [1]
The overall heterogeneity between studies was high (I2 = 0% in Randomized controlled trials (RCT), I2 = 79% in non-RCTs and I2 = 82% in overall 10 studies), and a random-effects model was used, and the results showed that the computer-assisted group had lower operating times than the traditional method group (MD = − 8.84, 95% 95% Confidence interval (CI): − 12.65, − 5.03; P < 0.00001)
The results showed that the Harris score was higher in the computer-assisted group than in the traditional method group (SMD = 0.69, 95% CI: 0.36, 1.01; P < 0.0001)
Summary
The femoral neck fracture is the most common hip fracture, which often occurs in elderly patients with osteoporosis, and it accounts for 3.58% and 54% of systemic fractures and hip fractures [1]. Femoral neck fracture has become a thorny problem in clinical treatment. Surgery is the first choice of therapy for femoral neck fractures. For femoral neck fractures without displacement or where satisfactory reduction has been obtained, the most common treatment is an internal fixation with closed reduction hollow screws [4, 5]. Several studies have shown that an inverted equilateral triangle is formed between a screw and another closed one, effectively preventing the femur’s subtrochanteric fracture and providing better biomechanical stability [6, 7]. Accurate screw placement can increase the stability of internal fixation of a femoral neck fracture and reduce the risk of nonunion [8, 9]
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