股骨近端防旋髓内钉与髋关节置换术治疗高龄股骨粗隆间骨折Meta分析

Efficacy of PFNA and hip arthroplasty in the treatment of elderly intertrochanteric fractures:A meta-analysis

目的通过Meta分析比较股骨近端防旋髓内钉(PFNA)与髋关节置换术治疗老年股骨粗隆间骨折的疗效。方法计算机检索2005-2018年发表有关PFNA与髋关节置换术对比治疗老年股骨粗隆间骨折的外文文章,选取随机对照研究(RCT)和临床对照研究(CCT)的文献,纳入符合要求的文献进行Meta分析,评价指标:手术时间(min)、术中出血量(mL)、术后Harris功能评分、术后下地负重时间(d)、术后并发症、再手术率。结果共纳入6篇英文文献,共672例研究对象,其中PFNA组329例,髋关节置换术组343例。Meta分析结果显示:PFNA组手术时间短,出血少,术后有关手术并发症少,术后Har-ris功能评分高;但髋关节置换组下地时间早,两者术后再次手术率差异无统计学意义。结论 PFNA治疗老年股骨粗隆间骨折有一定的优势,但临床需综合多方面因素,选择合适的手术方式。

Objective To compare the clinical efficacy of proximal femoral nail antirotation(PFNA)versus hip arthroplasty for intertrochanteric fracture in the elderly by meta analysis. Methods English language articles published in 2005-2018, which was on the comparison of PFNA versus hip arthroplasty for intertrochanteric fracture in the elderly were searched on computer. Articles of randomized controlled trial( RCT) and controlled Clinical Trail( CCT) qualified were collected and enrolled in the meta analysis. The evaluation indexes were:Surgical time (m in), Intraoperative blood loss( mL), Harris Hip Score,Time to partial weight bearing( day), Complications, Reoperation rate. Results A total of 6 articles including 672 patients,of which 392 cases were treated with PFNA while 343 cases treated with hip arthroplasty,were carefully enrolled in the study. The results showed that PFNA had advantages over hip arthroplasty in the aspects of shortening the operation time,reducing surgical blood loss volume,less postoperative complications and higher Harris functional scores,but the group of hip arthroplasty had an earlier time to partial weight bearing,and there were no statistical differences between them in the results of reoperation rate. Conclusion PFNA has some certain advantages in the treatment of elderly intertrochanteric fractures. However,the best surgical treatment should be choose according to various factors for the elderly patients with intertrochanteric fractures.