The Effects Of Arthroplasty Versus Internal Fixation On Intertrochanteric Fracture In Senile Patients: A Meta-analysis

Objects: To estimate the effects and complications of arthroplasty versus internal fixation(IF) on intertrochanteric fracture in the senile patients by conducting a meta analysis, and further provide a clinical evidence for the operation choice of intertrochanteric fracture.Methods: 1. Based on the objects, establish detailed inclusion and exclusion criteria, including the characters of the patients, intervention methods and the outcomes.2. Based on establishing critical searching criteria, systematically retrieve Cochrane Library, Pubmed database, Embase database, CBM, CNKI AND VIP databases, and manually retrieve the relative references and Orthopaedic journals. The random clinical trails(RCTs) focusing on comparing the effects of arthroplasty, hemiarthroplasty, bipolar prosthetic arthroplasty with IF, Inter TAN,dynamic hip screw(DHS), Gamma nail and proximal femoral nail anti-rotation(PFNA) were included.3. Conduct a quality assessment for the included studies based on the Cochrane recommended.4. Extract the relative data, and employ the Revman5.1.0 software to make a meta analysis.Results: the research included nine RCTs including 901 patients which 405 patients treated by arthroplasty, 213 patients by DHS and 205 by PFNA. For operating time, bleeding volum during operating and mortality, no significantly difference had found between arthroplasty and IF; the average hospitalization time in arthroplasty group was significantly decreased compared the IF group(WMD=-5.36;95%CI :-9.82,-0.91;P=0.02); the weight-bearing time in arthroplasty group was shorter than IF group(WMD=-33.99; 95%CI:-47.30,-20.68; P<0.0001); the incidence of internal complications on arthroplasty group was lower than IF group(OR:0.54; 95%CI:0.31,0.93; P=0.03); the incidence of implant-relative complications in arthroplasty group was lower than IF group(OR=0.24; 95%CI:0.10, 0.56; P=0.001); for the excellent rate of joint function during the following-up, arthroplasty group was significantly higher than IF group(WMD=1.78; 95%CI:1.10,2.88; P=0.02); for the Harris scores, arthroplasty group was significantly higher than DHS group(WMD=14.47; 95%CI:4.50,24.44; P=0.004).Conclusions: Comparing with DHS and PFNA, arthroplasty could not improve the blooding volum and mortality, but could obviously decline the time of hospitalization and bedridden, and effectively improve the recovery of joint functions. Thus, for the senile patients with intertrochanteric fracture, arthroplasty might be recommended as the preferred treatment.