InterTan髓内钉与股骨近端防旋髓内钉治疗老年性股骨粗隆间骨折的Meta分析

Meta-analysis of fixation efficacy of Intertan nail versus PFNA in treatment of femoral intertrochanteric fractures in elderly patients

目的通过meta分析评价股InterTan髓内钉与骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的疗效差异,评估两种手术方法的优劣。方法通过计算机检索Pubmed、Medline、Cochrane Library等外文数据库和万方、知网、维普等中文数据库中2014年10月至2017年6月发表的比较InterTan与PFNA治疗老年股骨粗隆间骨折疗效的随机对照及回顾性队列研究的相关文献,比较InterTan组与PFNA组的手术时间、术中出血量、骨性愈合时间、Harris功能评分优良率、术后尖顶距(TAD)、术后总体并发症、内固定失败率、切口感染率、骨折不愈合率。由2位系统评价员做独立的文献筛查、资料提取和质量评价,采用Rev Man5.3软件进行meta分析。结果共纳入10篇文献918例患者,其中InterTan组472例,PFNA组446例。PFNA组手术时间、术中出血量均低于InterTan组(P均<0.05),两组骨性愈合时间、术后随访Harris评分、术后TAD、切口感染率、骨折不愈合率比较差异均无统计学意义(P均>0.05)。InterTan组术后总体并发症发生率、内固定失败率少于PFNA组,两组比较差异有统计学意义(P<0.05)。结论 PFNA和InterTan系统治疗老年股骨粗隆间骨折均可取得良好效果,建议身体条件差和不能耐受长时间手术的患者可选择PFNA治疗,否则,InterTan系统治疗是更好的选择。

Objective To compare the fixation efficacy difference between Intertan nail and proximal femoral nail antiradiation(PFNA)in treating those elderly patients with femoral intertrochanteric fractures,and to evaluate their advantages and disadvantages by meta-analysis.Methods The related literatures of randomized controlled trials or retrospective cohort studies comparing Intertan nail and PFNAin treatment of elderly patients with femoral intertro chanteric fractures,published between Oct 2014 and Jun 2017 and indexed by such foreign databases as PubMed,Medline,Cochrane Library and such Chinese databases as Wanfang,CNKI,VIPand so on,were searched.Literature screening,data extraction and quality evaluation were separately performed by two reviewers,and such indexes asduration of surgery,intraope rative blood loss,excellent rate of Harris joint function score,postoperativetip-cortex distance(TAD),Harris hip score,time to bonyunion,postoperative complications,rate of incision infection,rate of inner fixation failure and rate of fracture nonunion,were compared between the patients receiving Intertan nailand PFNA.The software RevMan5.3 was used for further meta-analysis.Results A total of 918 patients from ten pieces of selected articles were included in this meta-analysis(472 patients of the Intertan nail group and 446 patients of the PFNAgroup).Although duration of surgery and blood loss in the PFNA group were both significantly less than thosein the Intertan nail group(P<0.05),but there was no significant difference in the time to bony union,post operative Harris hip score and TAD,rate of incision infection and rate of fracture nonunion between the PFNA andIntertan nail groups(P>0.05).The Intertan nail group had lower rates of post operative complications and inner fixation failure than those in the PFNA group,with significant differences between them(P<0.05).Conclusion Both of Intertan nailand PFNA system could beused as areasonable choice for the treatment of femoral intertrochanteric fractures in elderly patients.Patients with poor physical condition sand tolerance for long operation time are well suited for PFNA fixation;otherwise Intertan nail system may be apreferable choice.