| Objective:To make systematic analysis of the clinic therapeutic effects of the aged patients with Unstable intertrochanteric fractures treated by two fixation methods as proximal femoral nail anti-rotation (PFNA) intramedullary fixation and dynamic hip screw (DHS) extramedullary nail plate fixation, hoping to provide evidence for clinic treatment.Methods:Adopt computer to search English databases like Cochrane Library, Embase, Medline and PubMedand, and Chinese database like WANFANG Med, CNKI, Vip Med and China Bio-pharmaceutical. Manually search the domestic journals within 5 years like Chinese Journal of Surgery, Chinese Journal of Orthopaedics, Chinese Journal of Traumatology, Chinese Journal of Orthopaedic Trauma, Chinese Journal of Bone and Joint Injury, the Orthopedic Journal of China and Journal of Kunming Medical University. Collect all literature in accordance with inclusive criteria and two valuators will judge the methodological quality and collect data of the included researches according to modified Jadad score system and latest quality score system. When the opinions turn to be different, two valuators will negotiate or the third party expert will make decision. Finally, adopt RevMan 5.3 software to process Meta analysis for data.Results:According to the established inclusive criteria and exclusive criteria,10 literature researches are included into this study, one in English and 9 in Chinese.715 cases are included,366 cases into PFNA group and 349 into DHS group. According to modified Jadad quality score system,1 research is high qualified and 9 researches are low qualified. According to Meta analysis results, they have statistic significance in the differences of mean operation time (MD=-24.79,95%CI:-35.07～-14.51, P<0.00001), mean bleeding volume (MD=-201.28,95%CI:-229.13～-173.43, P<0.00001), operative incision length (MD=-7.80,95%CI:-8.58～-7.01, P<0.00001), post-operative excellent rate (OR=4.90,95%CI:2.89～8.32, P<0.00001), post-operative complication rate (OR=0.46,95%CI:0.26～0.80, P=0.006) and hospital stays (OR=0.46,95%CI:0.26～0.80, P=0.006).Conclusion:Compared with traditional classic surgery of DHS extramedullary nail plate system, PFNA intramedullary fixation system has obvious advantages in mean operation time, mean bleeding volume, operative incision length, post-operative excellent rate, post-operative complication rate and hospital stays. However, the differences in race, region, operator and bone quality exert effects on all indexes. Further study shall be processed by strictly designing randomized-controlled trial. |
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