股骨近端防旋髓内钉与InterTan髓内钉治疗股骨转子间骨折疗效比较的Meta分析

Clinical outcomes of proximal femoral nail antirotation versus InterTan nail in treatment of femoral intertrochanteric fractures： a Meta analysis

目的 系统评价股骨近端防旋髓内钉（PFNA）与InterTan髓内钉治疗股骨转子间骨折的安全性与疗效. 方法 计算机检索Cochrane图书馆、Medline数据库、中国知网、万方数据库、中国生物医学文献数据库、PubMed和Ovid等数据库,以及所有关于PFNA（PFNA组）与InterTan髓内钉（InterTan髓内钉组）治疗股骨转子间骨折的临床对照试验.比较两组患者的手术时间、术中出血量、骨折愈合时间、末次随访时髋关节Harris评分及术后并发症等.采用RevMan 4.2统计学软件进行Meta分析. 结果 共纳入7篇文献（应用Jadad质量评分法评定文献质量：1篇文献为7分,6篇文献为2分）,包括491例患者（均为单侧）,PFNA组266例,InterTan髓内钉组225例.Meta分析结果显示：PFNA组患者的手术时间较InterTan髓内钉组短,差异有统计学意义[WMD=-15.58,95％ CI（-21.60,-9.56）,P＜0.001].PFNA组患者末次随访时髋关节Harris评分较InterTan髓内钉组低,差异有统计学意义[WMD=-2.33,95％ CI（-4.14,-0.53）,P=0.01].两组患者的术中出血量[WMD=-33.89,95％ CI（-71.88,4.11）,P=0.08]、骨折愈合时间[WMD=1.60,95％ CI（-2.32,5.52）,P=0.42]及术后并发症[OR=1.90,95％ CI（0.98,3.69）,P=0.06]比较差异均无统计学意义. 结论 虽然InterTan髓内钉治疗股骨转子间骨折的手术时间较PFNA长,但其手术风险并没有明显升高;且术后髋关节功能较PFNA好.

Objective To compare the safety and the clinical outcomes between proximal femoral nail antirotation （PFNA） and InterTan nail in treatment of femoral intertrochanteric fracture using a Meta analysis.Methods A computer-based online search was performed of the Cochrane library,Medline database,CNKI,Wan Fang database,the Chinese Biomedical Literature Database,PubMed,Ovid database for clinical trials regarding PFNA and InterTan nail in the treatment of femoral intertrochanteric fractures.A Meta analysis was done to compare operation time,intraoperative bleeding,time for fracture healing,postoperative Harris hip score,and postoperative complications between the 2 groups using statistical software RevMan 4.2.Results A total of 7 studies were included （one of 7 points and 6 of 2 points by Jadad quality grading）,involving 491 patients （all one-sided）.PFNA was used in 266 patients and InterTan nail in 225.The operation time in the PFNA group was significantly shorter than in the InterTan nail group [WMD=-15.58,95% CI （-21.60,-9.56）,P 〈0.001].The Harris hip score at the last follow-up was significantly lower in the PFNA group than in the InterTan nail group[WMD =-2.33,95% CI （-4.14,-0.53）,P =0.01].There were no statistically significant differences between the 2 groups in bleeding volume [WMD =-33.89,95% CI （-71.88,4.11）,P =0.08],bone healing time [WMD =1.60,95% CI （-2.32,5.52）,P =0.42],or postoperative complications [OR =1.90,95% CI （0.98,3.69）,P =0.06].Conclusions Although InterTan nail may lead to longer operation time than PFNA,the risk of surgery may not be much increased and the former has an advantage of better hip functional recovery than the latter.