Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
Int Orthop. 2020 Apr;44(4):623-633. doi: 10.1007/s00264-019-04351-9. Epub 2019 Jun 14.
Unstable intertrochanteric femoral fractures in the elderly require either fixation or joint sacrificing surgery; proximal femoral nail (PFN) and bipolar hemiarthroplasties (BPH) are the most common interventions. PFN is considered to be the ideal construct for these fractures; however, the usage of hemiarthroplasties to facilitate earlier mobilization has been on a rise. Currently there is no consensus on the superiority of one of these two techniques over the other and the present review was done to determine this.
Is PFN a better alternative to BPH for unstable intertrochanteric femur fractures in the elderly?
The present systematic review and meta-analysis was conducted to determine the superiority of PFN over BPH by comparing the primary outcomes like mortality, Harris Hip scores (HHS), complications, and re-operations. Additionally, secondary outcomes like blood loss, duration of surgery, and period of hospital stays were also compared.
Three databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles that directly compared PFN and BPH in unstable intertrochanteric femur fractures in the elderly.
We analyzed a total of seven studies published between the years 2005 to 2017. There were four retrospective and three prospective randomized controlled studies. The number of patients in these studies ranged from 53 to 303.
There was a significant difference in HHS between two groups with standard mean difference of - 0.51 (range - 0.67 to -0.36), favouring the PFN group. The rate of mortality was higher in the BPH group with odds ratio of 2.07 (range 1.40-3.08). Implant-related complications like fractures and subsidence were more in BPH group but this was not significant.
Mean surgical time (standard mean difference 2.19) and blood loss (3.75) were significantly less in the PFN group. The duration of hospital stay was also found to be significantly less in the PFN group (2.66).
Proximal femoral nails are superior to bipolar hemiarthroplasties for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally it is faster surgery, with lesser blood loss contributing to better results.
老年人不稳定型股骨转子间骨折需要固定或关节牺牲手术；股骨近端髓内钉（PFN）和双极半髋关节置换术（BPH）是最常见的干预措施。PFN 被认为是治疗这些骨折的理想结构；然而，为了促进早期活动而使用半髋关节置换术的情况有所增加。目前，对于这两种技术中的哪一种更具优势尚无共识，因此进行了本次综述以确定这一点。
PFN 是否是治疗老年人不稳定型股骨转子间骨折的更好选择？
本系统评价和荟萃分析旨在通过比较死亡率、Harris 髋关节评分（HHS）、并发症和再手术等主要结局，确定 PFN 相对于 BPH 的优势。此外，还比较了次要结局，如失血量、手术时间和住院时间。
在 PubMed、EMBASE 和 SCOPUS 三个数据库中搜索了直接比较老年人不稳定型股骨转子间骨折中 PFN 和 BPH 的相关文章。
我们分析了 2005 年至 2017 年期间发表的总共 7 项研究。这些研究包括 4 项回顾性研究和 3 项前瞻性随机对照研究。这些研究中的患者人数从 53 人到 303 人不等。
两组间 HHS 存在显著差异，标准均数差为-0.51（范围-0.67 至-0.36），PFN 组更优。BPH 组的死亡率更高，优势比为 2.07（范围 1.40-3.08）。BPH 组的植入物相关并发症（如骨折和下沉）更多，但无统计学意义。
PFN 组的平均手术时间（标准均数差 2.19）和失血量（3.75）显著减少。PFN 组的住院时间也明显缩短（2.66）。
在老年人不稳定型股骨转子间骨折中，股骨近端髓内钉优于双极半髋关节置换术。PFN 可带来更好的功能结局，并降低总死亡率。此外，它是一种更快的手术，失血量更少，有助于取得更好的效果。
