Dynamic Hip Screw Versus Proximal Femoral Nail Anti-rotation In Treatment Of Intertrochanteric Fracture The Elderly:a Meta-anlyisis

Intertrochanteric fracture happens in the elderly.In theChina’s aging population,Hip fracture have about6.6million people,among then there are about2.5-3million for intertrochantericfractures which Second only to femoral neck fracture,and accountedfor3-4%of the whole body bone fracture。Patients average age are70, The number of female patients more than male patients.As theageing population increase, Elderly care system development lagsbehind, and the transportation,construction industry development,The intertrochanteric fracture Incidence increased year by year.Elderly femoral intertrochanteric fracture, Conservativetreatment cannot get satisfactory curative effect, which easilyconcurrent with pressure ulcers, hypostatic pneumonia,deep veinthrombosis and so on.they are Leading to a high mortalityrater.Intertrochanteric fractures, due to the broken ends offractured bone in intertrochanteric fracture is cancellous bone,blood supply is rich, rarely appear fracture non-unions.but becauseof osteoporosis, internal fixation failure reasons, such as concurrent hip varus deformity. Even fracture healing, Thepatient’s hip joint function as a result of hip varus deformity,muscle atrophy cannot get a good recovery. If there have not clearsurgical contraindications, choose appropriate surgical approachto the surgical treatment of early postoperative functionalexercise, the recovery of joint function, reduce mortality, preventthe happening of the complications is important.ObjectiveThis study based on the literature had been published in nealy10years which about the elderly femoral intertrochantericfractures,and about the Meta analysis who discuss the follow-upresearch literature about proximal femoral intramedullary nailanti rotation type compare with dynamic hip screw in the clinicalcurative effect of surgical treatment.In order to understand thequality of literature.To find the relevant evidence tocomprehensive comparative evaluation of elderly femoralintertrochanteric fractures which treatment of PFNA or DHSsurgery,Compare the operation time,Intraoperative blood loss,postoperative dykes, and surgical complications,the time ofhospital stay, hospital cost, etc Clinical problems.For clinicaldecision making and the next step of research to provide certainbasis.Materials and methodsRetrieve the documents form Medline, EMBASE and CENTRAL(TheCochrane central register of controlledtrials)foreign languagedatabase, And retrieve the documents form chinese journal netdatabase (CNKI), chinese sci-tech periodical full-text databaseand VIP,wanfang Chinese academic conference papers (CACP),wanfang Chinese dissertations database (CDDB), etc.Collect clinicalrandomized controlled studies published at home and abroad,Then usecomputer searching Medline (1950-2013.3) Ovid search engines suchas database, manually by Ovid search engine retrieval "clinicalorthopaedics&related research","Injury" and so on.Documentretrieval follow the Multi-Channel principle to get the most outof it.Then strict screening of related literature,choice can beincluded in the information, collect related long-term follow-upreports, according to the modified the Jadad scale to evaluate theliteratures.Finally determine the literature and related caseswhich can be incorporated into the Meta analysis.Download providedby the Cochrane collaboration RevMan5.0windows java6softwareReview Manager for analysis which include heterogeneity test,theeffect of merged statistics analysis, and drawing forest map aboutoperation time, blood loss, postoperative fine rate, postoperativecomplications,and drawing funnel chart to analysis published sexbias.ConclusionThrough the final evaluation and incorporating10literaturesinto the Meta analysis.Among4english literatures and6Chineseliteratures.All the literatures contains885cases ofintertrochanteric fracture patients,And in the cases,the DHS groupincluding445cases of patients,The PFNA group including440cases.Pass through the Meta analysis software statisticalcalculation,Draw a conclusion that the patients who are accept thePFNA surgery treatment compares the patients who are accept the DHSsurgery treatment, The group of PFNA spend less operation time,lesssurgical blood loss and more femoral fractures risk than group of DHS,Significant conclusions(P＜0.05).Comparison the DHS group andthe PFNA group that the excellent after surgery,the time of hospitalstays and wound infection after surgery had no significant sexdifferences(P＞0.05）.That illustration Senile intertrochantericfracture who accept PFNA surgical operation will spend lessopration time,less surgical blood loss and have more femoralfractures risk than who accept DHS surgical operation.