Interlocking intramedullary nail for proximal femur versus proximal femoral anti-rotation intramedullary nail or proximal femoral anti-rotation intramedullary nail of asian for intertrochanteric fractures in older adults: A meta-analysis
10.3969/j.issn.2095-4344.2989
- Author:
Liu CHANG
1
Author Information
1. Shanxi Medical University
- Publication Type:Journal Article
- Keywords:
Bone;
Femor;
Fixation;
Fracture;
Implant;
Intertrochanteric fracture;
Intramedullary nail;
Meta-analysis
- From:
Chinese Journal of Tissue Engineering Research
2021;25(3):477-485
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE: The most commonly used intramedullary fixation systems for the treatment of elderly intertrochanteric fractures include the proximal femoral anti-rotation intramedullary nail (PFNA), the proximal femoral anti-rotation intramedullary nail of Asian (PFNA-II) and interlocking intramedullary nail for proximal femur (Inter-TAN), but the clinical effect of the three in the treatment of A2 and A3 type intertrochanteric fractures is still controversial. Meta-analysis was used to compare the clinical efficacy of Inter-TAN, PFNA, and PFNA-II in the treatment of unstable intertrochanteric fractures in the elderly. METHODS: A computer was used to search databases such as Cochrane, Embase, PubMed, Sinomed, CNKI, Wanfang, and VIP to collect and compare the literatures of Inter-TAN, PFNA, and PFNA-II in the treatment of elderly unstable intertrochanteric fractures. The search period was from the establishment of the database to December 2019. Two reviewers independently read the screening literature, extracted data and evaluated the quality. Meta-analysis was performed using RevMan5.3 software. RESULTS: (1) A total of eight studies were included, with 1 349 patients, including two randomized controlled studies and six cohort studies. The evidence level was ≥ III. (2) Meta-analysis showed that the operation time and intraoperative fluoroscopy time were longer, and intraoperative blood loss was more in the Inter-TAN group than those of the PFNA-II group [MD=-16.60, 95%CI (-23.22,-9.99), P <0.05; MD=-1.85, 95%CI (-2.53,-1.16), P <0.05; MD=-9.83, 95%CI (-12.66,-6.99), P <0.000 01], with no significant difference compared with PFNA group (P >0.05). There was no significant difference in tip-apex distance, length of hospital stay, and Harris score of Inter-TAN group compared with PFNA group and PFNA-II group (P > 0.05). The incidence of postoperative screw cut-out in the Inter-TAN group was less than in the PFNA group and the PFNA-II group [OR=6.47, 95%CI(2.79, 15.00), P < 0.05; OR=5.88, 95%CI(1.29, 26.69), P <0.05]. The incidence of hip or thigh pain in the Inter-TAN group was less than that in the PFNA group and the PFNA-II group [OR=2.57, 95%CI(1.19, 5.52), P < 0.05; OR=3.20, 95%CI(-1.56, 6.55), P <0.05]. Postoperative femoral shaft fractures in the Inter-TAN group were less than those in the PFNA group and PFNA-II group [OR=3.87, 95%CI(1.75, 8.57), P <0.05; OR=7.06, 95%CI(1.24, 40.07), P <0.05]. The incidence of postoperative secondary surgery in the Inter-TAN group was less than in the PFNA group [OR=4.10, 95%CI(2.45, 6.86), P <0.05], and there was no significant difference compared with PFNA-II group (P >0.05). CONCLUSION: For patients with osteoporosis and poor stability, Inter-TAN can provide better stability and reduce postoperative complications. For patients with poor general conditions and greater surgical risk, PFNA-II internal fixation can be selected.
