股骨近端防旋髓内钉与 InterTAN 钉治疗股骨转子间骨折的临床疗效比较：一项荟萃分析。
Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: a meta-analysis.
机构信息
Department of Orthopaedics, Xiang'an Hospital, School of Medicine, Xiamen University, Xiamen, 361102, China.
Graduate School, Tianjin Medical University, Tianjin, 300070, China.
出版信息
J Orthop Surg Res. 2020 Oct 29;15(1):500. doi: 10.1186/s13018-020-02031-8.
BACKGROUND
A meta-analysis to access the pros and cons of proximal femoral nail anti-rotation (PFNA) versus InterTAN nail for intertrochanteric femoral fractures including available evidence extracted from literature.
METHODS
According to the Cochrane systemic analysis method, randomized control trials (RCTs) and retrospective comparative observational studies which were related to the comparison of PFNA and InterTAN nail in the treatment of the elderly with intertrochanteric fractures were retrieved. Data were independently extracted from the included studies by two reviewers and analyzed using RevMan 5.3, and the quality of the studies was assessed.
RESULTS
Two RCTs and seven observational studies were recruited, which consisted of 681 patients with PFNA and 651 patients with InterTAN nail. The meta-analyses showed no significant differences between the two approaches on Harris Hip Score, operation time, blood loss, time to union, mean hospital stay, union problems, intraoperative complications, hematoma, infection, and other complications in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip-apex distance and reduced pain at thigh or hip in InterTAN nail than in PFNA; however, InterTAN nail was not superior to PFNA in cutout, reoperation, and femoral shaft fracture; for observational studies, the risk of the screw migration (RR = 5.13, 95%CI [1.33,19.75], P = 0.02), cutout (RR = 3.26, 95%CI [1.64,6.47], P = 0.0008), the varus collapse of the femoral head (RR = 7.19, 95%CI [2.18,23.76], P = 0.001), femoral shaft fracture (RR = 5.73, 95%CI [2.24,14.65], P = 0.0003) treated by InterTAN nail were significantly decreased, compared with those by PFNA; however, no significant differences were observed in the aspects of tip-apex distance and pain at thigh or hip between these two groups.
CONCLUSION
Analysis of a large number of relevant clinical indicators available shows that InterTAN nail has better clinical manifestation than PFNA in treating unstable femoral intertrochanteric fractures.
背景
一项荟萃分析旨在评估股骨近端防旋髓内钉（PFNA）与 InterTAN 钉治疗股骨转子间骨折的优缺点，包括从文献中提取的现有证据。
方法
根据 Cochrane 系统分析方法，检索了与 PFNA 和 InterTAN 钉治疗老年股骨转子间骨折的比较相关的随机对照试验（RCT）和回顾性对照观察性研究。由两位评审员独立从纳入的研究中提取数据，并使用 RevMan 5.3 进行分析，同时评估研究的质量。
结果
共纳入 2 项 RCT 和 7 项观察性研究，包括 681 例接受 PFNA 治疗和 651 例接受 InterTAN 钉治疗的患者。荟萃分析显示，在 RCT 和观察性研究中，两种方法在 Harris 髋关节评分、手术时间、出血量、愈合时间、平均住院时间、愈合问题、术中并发症、血肿、感染和其他并发症方面均无显著差异。在其他结果方面，对于 RCT 研究，结果表明 InterTAN 钉的尖端-顶点距离更短，大腿或臀部疼痛减轻；然而，InterTAN 钉在切出、再次手术和股骨干骨折方面并不优于 PFNA；对于观察性研究，螺钉迁移的风险（RR = 5.13，95%CI [1.33,19.75]，P = 0.02）、切出（RR = 3.26，95%CI [1.64,6.47]，P = 0.0008）、股骨头内翻塌陷（RR = 7.19，95%CI [2.18,23.76]，P = 0.001）和股骨干骨折（RR = 5.73，95%CI [2.24,14.65]，P = 0.0003）的风险降低，与接受 PFNA 治疗的患者相比，InterTAN 钉治疗的患者显著降低；然而，两组间尖端-顶点距离和大腿或臀部疼痛方面无显著差异。
结论
对大量相关临床指标的分析表明，InterTAN 钉在治疗不稳定股骨转子间骨折方面的临床疗效优于 PFNA。
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