InterTAN与股骨近端防旋髓内钉内固定治疗股骨转子间骨折疗效和安全性的Meta分析

Clinical curative effects and safety of internal fixation with InterTAN nail versus proximal femoral nail antiro-tation for treatment of femoral intertrochanteric fractures:a meta analysis

目的:比较InterTAN与股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定治疗股骨转子间骨折的疗效和安全性。方法:应用计算机检索PubMed、Embase、Springer、The Cochrane Library、中国知网和万方数据库中关于InterTAN与PFNA内固定治疗股骨转子间骨折对比研究的文献,检索时限均为建库至2018年12月。PFNA组采用PFNA内固定治疗,Inter-TAN组采用InterTAN髓内钉内固定治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Revman5.3软件进行Meta分析。结果:共检索到356篇文献,最终纳入8篇,共涉及1335例患者。Meta分析结果显示,InterTAN组的手术时间、X线透视时间均比PFNA组长[MD=8.94,95%CI(1.10,16.78),P=0.030;MD=1.26,95%CI(0.40,2.11),P=0.004],术中出血量比PFNA组多[MD=21.58,95%CI(3.73,39.42),P=0.020];2组骨折愈合时间、髋关节Harris评分的组间差异均无统计学意义[MD=-0.53,95%CI(-1.09,0.03),P=0.070;MD=0.01,95%CI(-0.68,0.71),P=0.970];InterTAN组术后髋部及大腿疼痛的发生率、内固定失败率及翻修率均低于PFNA组[OR=0.36,95%CI(0.21,0.60),P=0.000;OR=0.26,95%CI(0.18,0.38),P=0.000;OR=0.31,95%CI(0.18,0.54),P=0.000]。结论:InterTAN与PFNA内固定治疗股骨转子间骨折,在骨折愈合时间和髋关节功能恢复方面没有明显差异,但PFNA内固定在控制手术时间、X线透视时间及术中出血方面具有优势,而InterTAN内固定在降低术后髋部及大腿疼痛发生率、内固定失败率及翻修率方面具有优势。

Objective:To compare the clinical curative effects and safety of internal fixation with InterTAN nail(ITN)versus proximal femoral nail antirotation(PFNA)in treatment of femoral intertrochanteric fractures.Methods:All randomized controlled trial(RCT)and nonRCT articles about clinical curative effects and safety of internal fixation with ITN(ITN group)versus PFNA(PFNA group)for treatment of femoral intertrochanteric fractures included from database establishing to December 2018 were retrieved from PubMed,Embase,Springer,The Cochrane Library,China national knowledge internet and WanFang Database through computer.The articles were screened and the information was extracted independently by two searchers according to the retrieval and screening scheme.The methodological quality of research in the articles was evaluated independently by the same two searchers and a Meta-analysis was conducted by using Revman5.3 software.Results:Three hundred and fifty-six articles were searched out.After screening,8 articles(1335 patients)were included in the final analysis.The results of Meta-analysis revealed that the operative time and X-ray fluoroscopy time were longer,and the intraoperative blood loss was more in InterTAN group compared to PFNA group(MD=8.94,95%CI(1.10,16.78),P=0.030;MD=1.26,95%CI(0.40,2.11),P=0.004;MD=21.58,95%CI(3.73,39.42),P=0.020).There were no statistical difference in fracture healing time and Harris hip scores between the 2 groups(MD=-0.53,95%CI(-1.09,0.03),P=0.070;MD=0.01,95%CI(-0.68,0.71),P=0.970).The incidence rates of postoperative hip and thigh pain,failure rate and revision rate of internal fixation were lower in InterTAN group compared to PFNA group(OR=0.36,95%CI(0.21,0.60),P=0.000;OR=0.26,95%CI(0.18,0.38),P=0.000;OR=0.31,95%CI(0.18,0.54),P=0.000).Conclusion:There is no obvious difference in fracture healing time and hip function recovery between ITN internal fixation and PFNA internal fixation in treatment of femoral intertrochanteric fractures.However,PFNA internal fixation has advantages in operative time,X-ray fluoroscopy time and intraoperative hemorrhage,while ITN internal fixation has advantages in reducing the incidence rates of postoperative hip and thigh pain,as well as failure rate and revision rate of internal fixation.