Chen Wen-Huan, Guo Wen-Xuan, Gao Shi-Hua, Wei Qiu-Shi, Li Zi-Qi, He Wei
The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China.
The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China.
World J Clin Cases. 2021 Nov 16;9(32):9878-9888. doi: 10.12998/wjcc.v9.i32.9878.
Proximal femoral nails (PFNs) are the most common method for the treatment of unstable intertrochanteric femoral fractures (IFFs), but postoperative bed rest is required. There is a large amount of blood loss during the operation. Osteoporosis in elderly patients may cause nonunion of fractures and other complications. Arthroplasty can give patients early weight bearing and reduce financial burden, but whether it can replace PFNs remains controversial.
To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.
A search was conducted in the PubMed, Embase, and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN. The search time was limited from January 1, 2005 to November 1, 2020. Two investigators independently screened studies, extracted data and evaluated the quality according to the inclusion and exclusion criteria. According to the research results, the fixed effect model or random effect model were selected for analysis. The following outcomes were analyzed: Harris Hip score, mortality, complications, operation time, blood loos, hospital stay, weight-bearing time, fracture classification and type of anesthesia.
We analyzed four randomized controlled trials that met the requirements. A total of 298 patients were included in these studies. According to the AO/OTA classification, there are 20 A1 types, 136 A2 types, 42 A3 types and 100 unrecorded types. Primary outcome: The Harris Hip Score at the final follow-up of the PFN group was higher [mean difference (MD): 9.01, 95% confidence interval (CI): 16.57 to 1.45), = 0.02]. There was no significant difference between the two groups in the rate of overall mortality [risk ratio (RR): 1.44, = 0.44] or the number of complications (RR: 0.77, = 0.05). Secondary outcomes: blood loss of the arthroplasty group was higher (MD: 241.01, 95% CI: 43.06-438.96, = 0.02); the operation time of the PFN group was shorter (MD: 23.12, 95%CI: 10.46-35.77, = 0.0003); and the length of hospital stay of the arthroplasty group was shorter [MD: 0.97, 95% CI: 1.29 to 0.66), < 0.00001]. There was no difference between the two groups in the type of anesthesia (RR: 0.99). There were only two studies recording the weight-bearing time, and the time of full weight bearing in the arthroplasty group was significantly earlier.
Compared with PFN, arthroplasty can achieve weight bearing earlier and shorten hospital stay, but it cannot achieve a better clinical outcome. Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.
股骨近端髓内钉（PFN）是治疗不稳定型股骨转子间骨折（IFF）最常用的方法，但术后需要卧床休息。手术过程中失血量大。老年患者的骨质疏松可能导致骨折不愈合及其他并发症。关节置换术可使患者早期负重并减轻经济负担，但它是否能替代PFN仍存在争议。
比较关节置换术与PFN治疗老年患者不稳定型IFF的临床疗效。
在PubMed、Embase和Cochrane图书馆数据库中进行检索，纳入比较关节置换术和PFN的相关文章。检索时间限制为2005年1月1日至2020年11月1日。两名研究者根据纳入和排除标准独立筛选研究、提取数据并评估质量。根据研究结果，选择固定效应模型或随机效应模型进行分析。分析以下指标：Harris髋关节评分、死亡率、并发症、手术时间、失血量、住院时间、负重时间、骨折分类及麻醉方式。
我们分析了4项符合要求的随机对照试验。这些研究共纳入298例患者。根据AO/OTA分类，有20例A1型、136例A2型、42例A3型及100例未记录类型。主要结局：PFN组末次随访时的Harris髋关节评分更高[平均差（MD）：9.01，95%置信区间（CI）：16.57至1.45，P = 0.02]。两组在总死亡率（风险比（RR）：1.44，P = 0.44）或并发症数量（RR：0.77，P = 0.05）方面无显著差异。次要结局：关节置换术组的失血量更多（MD：241.01，95%CI：43.06 - 438.96，P = 0.02）；PFN组的手术时间更短（MD：23.12，95%CI：10.46 - 35.77，P = 0.0003）；关节置换术组的住院时间更短[MD：0.97，95%CI：1.29至0.66，P < 0.00001]。两组在麻醉方式上无差异（RR：0.99）。仅有两项研究记录了负重时间，关节置换术组的完全负重时间明显更早。
与PFN相比，关节置换术可更早实现负重并缩短住院时间，但不能取得更好的临床疗效。在治疗老年患者不稳定型IFF方面，关节置换术不能替代PFN。
