Shi Jun-Jun, Wang Yu-Ze, Li Yuan, Gao Yuan-Peng, Wang Dong, Wang Zhi-Yong, Zhang Zhi-Qiang
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China;
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China.
Zhongguo Gu Shang. 2017 Oct 25;30(10):933-939. doi: 10.3969/j.issn.1003-0034.2017.10.011.
To system evaluate the clinical effect and safety of PFNA and InterTAN internal fixation methods for femoral intertrochanteric fracture.
According to the Cochrane systemic analysis method, randomized controlled trials and quasi-randomized controlled trials which were about the comparison of PFNA and InterTAN for intertrochanteric fracture were collected from Cochrane Library(2017, issue 4), PubMed (January, 2003-May, 2017), Wanfang Med Online (January, 2003-May, 2017) and China Academic Journals Full-text Database(January, 2003-May, 2017) by computer searching. Cross-checking was done after assessing the quality of the included trials and extracting the data by two reviewers independently. Data analysis were performed with RevMan 5.3.
Two randomized controlled trials and five quasi-randomized controlled trials involving 611 cases met the inclusion criteria. The meta-analyses showed no significant differences between the two methods on Harris scores[MD=-1.00, 95%CI(-2.29, 0.28), =0.13], union time[MD=0.04, 95%CI (-0.70, 0.77), =0.92], full weight-bearing time[MD=1.06, 95%CI(-0.29, 2.42), =0.13], hospital stay[MD=-0.04, 95%CI (-0.52, 0.45), =0.89] and length of incision[MD=-1.00, 95%CI (-2.64, 0.65), =0.23]. There were significant differences between the two methods on operative time[MD=-25.75, 95%CI (-37.47, -14.03), <0.000 1], intraoperative blood loss[MD=-55.67, 95%CI(-108.07, -3.27), =0.04] and the internal fixation complication rate[MD=4.17, 95%CI (1.33, 13.08), =0.01].
Both PFNA and InterTAN could provide good effect for intertrochanteric fracture. The operation time of PFNA is shorter than that of InterTAN, and there is less blood loss during operation. PFNA may be the first choice for the treatment of patients who have many complications and can't endure long-time operation. The complications of PFNA are more than those of InterTAN. In patients with long life expectancy and high requirements, InterTAN may be preferentially selected to reduce complications. According to the patient's situation, after a comprehensive consideration, appropriate treatment can be selected.
系统评价股骨粗隆间骨折采用股骨近端防旋髓内钉（PFNA）与InterTAN内固定方法的临床疗效及安全性。
按照Cochrane系统分析法，通过计算机检索Cochrane图书馆（2017年第4期）、PubMed（2003年1月至2017年5月）、万方医学网（2003年1月至2017年5月）及中国学术期刊全文数据库（2003年1月至2017年5月）中有关PFNA与InterTAN治疗股骨粗隆间骨折对比的随机对照试验和半随机对照试验。由两名评价员独立对纳入试验的质量进行评估及数据提取后交叉核对。采用RevMan 5.3软件进行数据分析。
两项随机对照试验和五项半随机对照试验共611例符合纳入标准。Meta分析显示，两种方法在Harris评分[MD=-1.00，95%CI（-2.29，0.28），P=0.13]、骨折愈合时间[MD=0.04，95%CI（-0.70，0.77），P=0.92]、完全负重时间[MD=1.06，95%CI（-0.29，2.42），P=0.13]、住院时间[MD=-0.04，95%CI（-0.52，0.45），P=0.89]及切口长度[MD=-1.00，95%CI（-2.64，0.65），P=0.23]方面差异无统计学意义。两种方法在手术时间[MD=-25.75，95%CI（-37.47，-14.03），P<0.000 1]、术中出血量[MD=-55.67，95%CI（-108.07，-3.27），P=0.04]及内固定并发症发生率[MD=4.17，95%CI（1.33，13.08），P=0.01]方面差异有统计学意义。
PFNA与InterTAN治疗股骨粗隆间骨折均能取得较好疗效。PFNA手术时间短于InterTAN，术中出血量少。对于合并多种并发症、不能耐受长时间手术的患者，PFNA可能是首选。PFNA并发症多于InterTAN。对于预期寿命长、要求高的患者，可优先选择InterTAN以减少并发症。应根据患者情况综合考虑后选择合适的治疗方法。
