Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China.
Department of Graduate School, Graduate Student Department of Changzhi Medical College, Changzhi, P.R. China.
PLoS One. 2024 Jul 9;19(7):e0304654. doi: 10.1371/journal.pone.0304654. eCollection 2024.
This meta-analysis compared the efficacy and safety of Proximal Femoral Nail Antirotation (PFNA) and InterTan Nail in the treatment of intertrochanteric fractures. Given the high incidence of femoral intertrochanteric fractures in the elderly population and its impact on quality of life, choosing the most effective and safest surgical option is crucial. PFNA and InterTan are currently two commonly used techniques, but there is a lack of systematic evaluation comparing their safety and effectiveness. This study aims to fill this knowledge gap through Meta-analysis, providing clinicians with evidence-based treatment recommendations.
A computer search was used to search for published literature on PFNA and InterTan in the treatment of intertrochanteric fractures in PubMed (Medline), Web of Science, Embase, Cochrane Library (CENTRAL), Cinahl, CBM, and CNKI.A total of 853 related literatures were retrieved, and 15 literatures were finally included. Newcastle-Ottawa-Scale and Cochrane systematic review methodologies were used to assess the quality of the literature. Meta-analysis was performed using Review Manager 5.4 software, following data extraction.
The comparison found that during the surgical treatment of intertrochanteric fractures, the operation time, fluoroscopy time, and blood loss in the PFNA group were significantly shorter than those in the InterTan group, and the difference was statistically significant. In terms of postoperative complication rates, the InterTan group had a significant advantage over the PFNA group. Shaft fracture, varus collapse, cut out, screw migration, and pain of hip and thigh were the most likely to occur in the PFNA group, and the differences were all statistically significant. In terms of postoperative efficacy, the results of the PFNA group and the InterTan group were comparable, and there was no significant differences.
When selecting surgical techniques for the treatment of femoral intertrochanteric fractures, it is necessary to conduct individualized assessments based on the patient's overall health status, surgical tolerance, and post-operative recovery needs. For patients who cannot tolerate long-term surgery or are in poor physical condition, PFNA may be more appropriate. While for patients who can tolerate long-term surgery or have more complex conditions, InterTan may be more suitable.
本荟萃分析比较了股骨近端防旋髓内钉（PFNA）和 InterTan 钉治疗股骨转子间骨折的疗效和安全性。鉴于老年人股骨转子间骨折的高发率及其对生活质量的影响，选择最有效和最安全的手术方案至关重要。PFNA 和 InterTan 目前是两种常用的技术，但缺乏系统的安全性和有效性评估。本研究旨在通过荟萃分析填补这一知识空白，为临床医生提供基于证据的治疗建议。
计算机检索 PubMed（Medline）、Web of Science、Embase、Cochrane 图书馆（CENTRAL）、Cinahl、CBM、CNKI 中关于 PFNA 和 InterTan 治疗股骨转子间骨折的已发表文献，共检索到 853 篇相关文献，最终纳入 15 篇文献。采用纽卡斯尔-渥太华量表和 Cochrane 系统评价方法评价文献质量。采用 Review Manager 5.4 软件进行 Meta 分析，并进行数据提取。
比较发现，在股骨转子间骨折的手术治疗中，PFNA 组的手术时间、透视时间和出血量明显短于 InterTan 组，差异有统计学意义。在术后并发症发生率方面，InterTan 组明显优于 PFNA 组。股骨干骨折、内翻塌陷、切出、螺钉迁移和髋大腿疼痛是 PFNA 组最常见的并发症，差异均有统计学意义。在术后疗效方面，PFNA 组和 InterTan 组的结果相当，差异无统计学意义。
在选择股骨转子间骨折的手术技术时，需要根据患者的整体健康状况、手术耐受性和术后恢复需求进行个体化评估。对于不能耐受长时间手术或身体状况较差的患者，PFNA 可能更为合适。而对于能够耐受长时间手术或病情较复杂的患者，InterTan 可能更为合适。
