Dynamic hip screw combined with anti-rotation screw <i>versus</i> cannulated screw alone for femoral neck fracture in adults: a meta-analysis_West China Medical Journal

Authors：

CHEN Bingze ¹ ,  WANG Xiaoping ²

1. Department of Spine Orthopedics, Jiangmen Central Hospital, Jiangmen, Guangdong 529000, P. R. China;
2. Department of Orthopedics, the Affiliated Xiaolan Hospital of Southern Medical University, Zhongshan, Guangdong 528415, P. R. China;

Corresponding?author：

WANG Xiaoping, Email: xpwang451820@126.com

Keywords：

Femoral neck fracture; dynamic hip screw; cannulated screw; anti-rotation screw; meta-analysis

DOI：

10.7507/1002-0179.202112071

Video：

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Objective To compare the efficacy and safety of dynamic hip screw (DHS) + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults. Methods PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, SinoMed, Wanfang, and Chongqing VIP database were searched for the literature related to the comparison between DHS + anti-rotation screw and cannulated screw alone for femoral neck fracture in adults from the establishment of databases to 2022. RevMan 5.3 software was used for meta-analysis. Results Finally, 25 clinical studies were included, including 8 randomized controlled trials and 17 observational studies, 5 in English and 20 in Chinese. There were a total of 2099 patients, including 989 in the DHS + anti-rotation screw group and 1110 in the cannulated screw group. The meta-analysis results showed that the incidence of bone nonunion [odds ratio (OR)=0.29, 95% confidence interval (CI) (0.17, 0.48)], incidence of femoral head necrosis [OR=0.48, 95% CI (0.27, 0.88)], failure rate of internal fixation [OR=0.28, 95% CI (0.15, 0.51)] in the DHS + anti-rotation screw group were lower than those in the cannulated screw group (P<0.05). The surgical duration [mean difference (MD)=9.91, 95% CI (6.78, 13.05)], incision length [MD=1.25, 95% CI (0.15, 2.35)], and Harris score [MD=6.77, 95% CI (4.66, 8.88)] in the DHS + anti-rotation screw group were higher than those in the cannulated screw group (P<0.05). There was no statistically significant difference in intraoperative bleeding volume, Visual Analogue Scale score, hospital stay, and fracture healing time between the two groups (P>0.05). The incidence of bone nonunion in the DHS + anti-rotation screw group after Pauwels type Ⅲ fracture [OR=0.16, 95% CI (0.05, 0.50)] was lower than that in the cannulated screw group (P<0.05), and there was no statistically significant difference in the incidence of femoral head necrosis between the two groups (P>0.05). Conclusions For femoral neck fracture in adults, DHS + anti-rotation screw can reduce the incidence of bone nonunion, femoral head necrosis, and internal fixation failure compared with cannulated screw alone, and has a higher Harris score, but the surgical duration and incision are longer. Overall, DHS + anti-rotation screw are better at reducing the incidence of complications than cannulated screws alone.

Citation： CHEN Bingze, WANG Xiaoping. Dynamic hip screw combined with anti-rotation screw versus cannulated screw alone for femoral neck fracture in adults: a meta-analysis. West China Medical Journal, 2023, 38(4): 550-558. doi: 10.7507/1002-0179.202112071 Copy

1.	中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
2.	Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006, 17(12): 1726-1733.
3.	張浩. 青壯年股骨頸骨折的內固定手術治療進展. 沈陽醫學院學報, 2021, 23(2): 182-185.
4.	徐凱航, 紀方. 青壯年股骨頸骨折的治療進展. 中華創傷骨科雜志, 2020, 22(6): 549-552.
5.	陳志兵, 王光林, 林佳生, 等. 空心螺釘與動力髖螺釘加防旋螺釘治療股骨頸骨折療效比較. 中國修復重建外科雜志, 2011, 25(1): 26-29.
6.	Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
7.	范克杰, 陳柯, 田可為, 等. 手法閉合復位聯合平行螺釘和偏軸螺釘內固定治療青壯年垂直不穩定型股骨頸骨折. 中醫正骨, 2020, 32(7): 47-50,54.
8.	Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: a finite element analysis. Injury, 2021, 52(8): 2116-2125.
9.	Li L, Zhao X, Yang X, et al. Dynamic hip screws versus cannulated screws for femoral neck fractures: a systematic review and meta-analysis. J Orthop Surg Res, 2020, 15(1): 352.
10.	Siavashi B, Aalirezaei A, Moosavi M, et al. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop, 2015, 39(10): 2069-2071.
11.	Bonnaire FA, Weber AT. Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck. Injury, 2002, 33(Suppl 3): C24-C32.
12.	江輝耀. 動力髖螺釘聯合防旋螺釘和空心加壓螺釘治療股骨頸骨折的療效比較. 中國醫藥科學, 2013(23): 210-212.
13.	Giordano V, Giordano M, Aquino R, et al. How do orthopedic surgeons manage displaced femoral neck fracture in the middle-aged patient? Brazilian survey of 78 orthopaedic surgeons. Rev Bras Ortop (Sao Paulo), 2019, 54(3): 288-294.
14.	曾憲濤, 莊麗萍, 楊宗國, 等. Meta 分析系列之七: 非隨機實驗性研究、診斷性試驗及動物實驗的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(6): 496-499.
15.	Slim K, Nini E, Forestier D, et al. Methodological Index For Non-Randomized Studies (MINORS): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
16.	劉粵, 鄭士偉, 劉樹義, 等. 三枚空心釘與動力髖螺釘結合空心釘治療青壯年股骨頸骨折的比較研究. 中國修復重建外科雜志, 2010, 24(9): 1149-1150.
17.	李煒. 空心螺釘與動力髖螺釘加防旋螺釘治療股骨頸骨折療效比較. 中國現代醫生, 2012, 50(16): 36-38.
18.	鄧賓, 胡栢均, 林志炯, 高大偉. 2 種內固定方式治療頭頸型股骨頸骨折的比較. 新中醫, 2013, 45(7): 51-52.
19.	梁西興, 趙莉. 空心加壓螺釘治療股骨頸骨折 60 例臨床分析. 當代醫學, 2014(22): 23-24.
20.	楊建軍. 不同類型內固定方法治療股骨頸骨折的臨床對比分析. 中外健康文摘, 2014(23): 97-98.
21.	趙喜東. 空心加壓螺釘治療股骨頸骨折療效分析. 大家健康(中旬版), 2014(12): 124.
22.	高悠水, 陳松, 周祖彬, 等. Pauwels 3 型股骨頸骨折的手術治療 46 例分析. 中國骨與關節雜志, 2015(2): 96-100.
23.	侯吳仁, 徐敏鷗. 動力髖螺釘加防旋螺釘與 3 枚空心螺釘治療股骨頸粉碎性骨折的療效比較. 中國骨傷, 2015, 28(9): 796-801.
24.	吳石華, 王朝暉, 張靜. Pauwels Ⅲ型股骨頸骨折空心螺釘與動力髖螺釘固定效果分析. 東方食療與保健, 2015, 1(1): 18-19.
25.	Zhang YL, Chen S, Ai ZS, et al. Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures: a retrospective cohort study. Medicine (Baltimore), 2016, 95(24): e3706.
26.	王齊, 韓國建, 張宇, 等. 兩種手術方法治療 PauwelsⅢ型股骨頸骨折的臨床效果分析. 中華骨與關節外科雜志, 2016, 9(5): 414-417.
27.	崔巍, 簡爭光, 孫雪峰, 等. DHS 結合中空加壓螺釘治療股骨頸骨折 30 例臨床效果分析. 中國醫藥指南, 2016, 14(35): 103-104.
28.	郭文彤. 動力髖螺釘聯合防旋螺釘對股骨頸骨折患者術后并發癥及功能恢復的臨床觀察. 泰山醫學院學報, 2016, 37(12): 1389-1390.
29.	尹廣政. 空心釘與動力髖螺釘加防旋螺釘內固定治療股骨頸骨折的療效比較. 中國骨與關節損傷雜志, 2016, 31(6): 28-29.
30.	屈鐵男. DHS 結合中空加壓螺釘治療股骨頸骨折 60 例的臨床效果分析. 三峽大學學報(自然科學版), 2017, 39: 129-131.
31.	饒漢榮, 陳駿欽. 股骨頸骨折空心釘與動力髖螺釘加防旋釘內固定的臨床對比研究. 內蒙古醫學雜志, 2018, 50(7): 826-827.
32.	汪波. 動力髖螺釘聯合防旋螺釘內固定對股骨頸骨折術后髖關節功能的影響. 內蒙古醫學雜志, 2018, 50(8): 979-981.
33.	Sharma A, Sethi A, Sharma S. Comparative analysis of treatment of basicervical femur fractures in young adults with CCS, DHS, and PFN. Rev Bras Ortop, 2018, 53(6): 783-787.
34.	Bisaccia M, Ceccarini P, Rinonapoli G, et al. Dhs plus anti-rotational screw vs cannulated screws for femoral neck fractures: an analysis of clinical outcome and incidence regarding avn. Acta Orthop Belg, 2018, 84(3): 279-283.
35.	王曉天, 施麗燕. 空心螺釘與動力髖螺釘加防旋螺釘治療股骨頸骨折療效比較. 大醫生, 2019, 4(16): 94-95.
36.	張紅崗. 不同術式治療 PauwelsⅢ型股骨頸骨折患者近期預后比較. 中國藥物與臨床, 2020, 20(11): 1851-1853.
37.	?ahin A, Agar A, Gülabi D, et al. Comparison of dynamic hip screw and antirotation screw with cannulated screw in the treatment of transcervical collum femoris fractures. Jt Dis Relat Surg, 2020, 31(2): 320-327.
38.	Dickson JA. The unsolved fracture; a protest against defeatism. J Bone Joint Surg Am, 1953, 35(4): 805-822.
39.	Duffin M, Pilson HT. Technologies for young femoral neck fracture fixation. J Orthop Trauma, 2019, 33(Suppl 1): S20-S26.
40.	Filipov O. The method of biplane double-supported screw fixation (BDSF) at femoral neck fractures - principle and clinical outcomes. J of IMAB, 2013, 19(1): 423-428.
41.	Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
42.	Baitner AC, Maurer SG, Hickey DG, et al. Vertical shear fractures of the femoral neck. A biomechanical study. Clin Orthop Relat Res, 1999(367): 300-305.
43.	Deneka DA, Simonian PT, Stankewich CJ, et al. Biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. J Orthop Trauma, 1997, 11(5): 337-343.
44.	Mahomed NN, Arndt DC, McGrory BJ, et al. The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty, 2001, 16(5): 575-580.
45.	Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am, 2008, 90(8): 1654-1659.
46.	Zlowodzki M, Jönsson A, Paulke R, et al. Shortening after femoral neck fracture fixation: is there a solution? Clin Orthop Relat Res, 2007, 461: 213-218.
47.	Aminian A, Gao F, Fedoriw WW, et al. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma, 2007, 21(8): 544-548.

1. 中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
2. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006, 17(12): 1726-1733.
3. 張浩. 青壯年股骨頸骨折的內固定手術治療進展. 沈陽醫學院學報, 2021, 23(2): 182-185.
4. 徐凱航, 紀方. 青壯年股骨頸骨折的治療進展. 中華創傷骨科雜志, 2020, 22(6): 549-552.
5. 陳志兵, 王光林, 林佳生, 等. 空心螺釘與動力髖螺釘加防旋螺釘治療股骨頸骨折療效比較. 中國修復重建外科雜志, 2011, 25(1): 26-29.
6. Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
7. 范克杰, 陳柯, 田可為, 等. 手法閉合復位聯合平行螺釘和偏軸螺釘內固定治療青壯年垂直不穩定型股骨頸骨折. 中醫正骨, 2020, 32(7): 47-50,54.
8. Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: a finite element analysis. Injury, 2021, 52(8): 2116-2125.
9. Li L, Zhao X, Yang X, et al. Dynamic hip screws versus cannulated screws for femoral neck fractures: a systematic review and meta-analysis. J Orthop Surg Res, 2020, 15(1): 352.
10. Siavashi B, Aalirezaei A, Moosavi M, et al. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults. Int Orthop, 2015, 39(10): 2069-2071.
11. Bonnaire FA, Weber AT. Analysis of fracture gap changes, dynamic and static stability of different osteosynthetic procedures in the femoral neck. Injury, 2002, 33(Suppl 3): C24-C32.
12. 江輝耀. 動力髖螺釘聯合防旋螺釘和空心加壓螺釘治療股骨頸骨折的療效比較. 中國醫藥科學, 2013(23): 210-212.
13. Giordano V, Giordano M, Aquino R, et al. How do orthopedic surgeons manage displaced femoral neck fracture in the middle-aged patient? Brazilian survey of 78 orthopaedic surgeons. Rev Bras Ortop (Sao Paulo), 2019, 54(3): 288-294.
14. 曾憲濤, 莊麗萍, 楊宗國, 等. Meta 分析系列之七: 非隨機實驗性研究、診斷性試驗及動物實驗的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(6): 496-499.
15. Slim K, Nini E, Forestier D, et al. Methodological Index For Non-Randomized Studies (MINORS): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
16. 劉粵, 鄭士偉, 劉樹義, 等. 三枚空心釘與動力髖螺釘結合空心釘治療青壯年股骨頸骨折的比較研究. 中國修復重建外科雜志, 2010, 24(9): 1149-1150.
17. 李煒. 空心螺釘與動力髖螺釘加防旋螺釘治療股骨頸骨折療效比較. 中國現代醫生, 2012, 50(16): 36-38.
18. 鄧賓, 胡栢均, 林志炯, 高大偉. 2 種內固定方式治療頭頸型股骨頸骨折的比較. 新中醫, 2013, 45(7): 51-52.
19. 梁西興, 趙莉. 空心加壓螺釘治療股骨頸骨折 60 例臨床分析. 當代醫學, 2014(22): 23-24.
20. 楊建軍. 不同類型內固定方法治療股骨頸骨折的臨床對比分析. 中外健康文摘, 2014(23): 97-98.
21. 趙喜東. 空心加壓螺釘治療股骨頸骨折療效分析. 大家健康(中旬版), 2014(12): 124.
22. 高悠水, 陳松, 周祖彬, 等. Pauwels 3 型股骨頸骨折的手術治療 46 例分析. 中國骨與關節雜志, 2015(2): 96-100.
23. 侯吳仁, 徐敏鷗. 動力髖螺釘加防旋螺釘與 3 枚空心螺釘治療股骨頸粉碎性骨折的療效比較. 中國骨傷, 2015, 28(9): 796-801.
24. 吳石華, 王朝暉, 張靜. Pauwels Ⅲ型股骨頸骨折空心螺釘與動力髖螺釘固定效果分析. 東方食療與保健, 2015, 1(1): 18-19.
25. Zhang YL, Chen S, Ai ZS, et al. Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures: a retrospective cohort study. Medicine (Baltimore), 2016, 95(24): e3706.
26. 王齊, 韓國建, 張宇, 等. 兩種手術方法治療 PauwelsⅢ型股骨頸骨折的臨床效果分析. 中華骨與關節外科雜志, 2016, 9(5): 414-417.
27. 崔巍, 簡爭光, 孫雪峰, 等. DHS 結合中空加壓螺釘治療股骨頸骨折 30 例臨床效果分析. 中國醫藥指南, 2016, 14(35): 103-104.
28. 郭文彤. 動力髖螺釘聯合防旋螺釘對股骨頸骨折患者術后并發癥及功能恢復的臨床觀察. 泰山醫學院學報, 2016, 37(12): 1389-1390.
29. 尹廣政. 空心釘與動力髖螺釘加防旋螺釘內固定治療股骨頸骨折的療效比較. 中國骨與關節損傷雜志, 2016, 31(6): 28-29.
30. 屈鐵男. DHS 結合中空加壓螺釘治療股骨頸骨折 60 例的臨床效果分析. 三峽大學學報(自然科學版), 2017, 39: 129-131.
31. 饒漢榮, 陳駿欽. 股骨頸骨折空心釘與動力髖螺釘加防旋釘內固定的臨床對比研究. 內蒙古醫學雜志, 2018, 50(7): 826-827.
32. 汪波. 動力髖螺釘聯合防旋螺釘內固定對股骨頸骨折術后髖關節功能的影響. 內蒙古醫學雜志, 2018, 50(8): 979-981.
33. Sharma A, Sethi A, Sharma S. Comparative analysis of treatment of basicervical femur fractures in young adults with CCS, DHS, and PFN. Rev Bras Ortop, 2018, 53(6): 783-787.
34. Bisaccia M, Ceccarini P, Rinonapoli G, et al. Dhs plus anti-rotational screw vs cannulated screws for femoral neck fractures: an analysis of clinical outcome and incidence regarding avn. Acta Orthop Belg, 2018, 84(3): 279-283.
35. 王曉天, 施麗燕. 空心螺釘與動力髖螺釘加防旋螺釘治療股骨頸骨折療效比較. 大醫生, 2019, 4(16): 94-95.
36. 張紅崗. 不同術式治療 PauwelsⅢ型股骨頸骨折患者近期預后比較. 中國藥物與臨床, 2020, 20(11): 1851-1853.
37. ?ahin A, Agar A, Gülabi D, et al. Comparison of dynamic hip screw and antirotation screw with cannulated screw in the treatment of transcervical collum femoris fractures. Jt Dis Relat Surg, 2020, 31(2): 320-327.
38. Dickson JA. The unsolved fracture; a protest against defeatism. J Bone Joint Surg Am, 1953, 35(4): 805-822.
39. Duffin M, Pilson HT. Technologies for young femoral neck fracture fixation. J Orthop Trauma, 2019, 33(Suppl 1): S20-S26.
40. Filipov O. The method of biplane double-supported screw fixation (BDSF) at femoral neck fractures - principle and clinical outcomes. J of IMAB, 2013, 19(1): 423-428.
41. Panteli M, Rodham P, Giannoudis PV. Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury, 2015, 46(3): 445-452.
42. Baitner AC, Maurer SG, Hickey DG, et al. Vertical shear fractures of the femoral neck. A biomechanical study. Clin Orthop Relat Res, 1999(367): 300-305.
43. Deneka DA, Simonian PT, Stankewich CJ, et al. Biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures. J Orthop Trauma, 1997, 11(5): 337-343.
44. Mahomed NN, Arndt DC, McGrory BJ, et al. The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty, 2001, 16(5): 575-580.
45. Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am, 2008, 90(8): 1654-1659.
46. Zlowodzki M, Jönsson A, Paulke R, et al. Shortening after femoral neck fracture fixation: is there a solution? Clin Orthop Relat Res, 2007, 461: 213-218.
47. Aminian A, Gao F, Fedoriw WW, et al. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma, 2007, 21(8): 544-548.

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Dynamic hip screw combined with anti-rotation screw versus cannulated screw alone for femoral neck fracture in adults: a meta-analysis

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