The Treatment Of Intertrochanteric Fractures In The Elderly With PFNA Or InterTAN:a Meta-analysisi And Clinical Curative Effect Analysis

Objective:1.This study is to find the differences of operative time, intraoperative bleeding,Time to full weight bearing,fracture healing time, hip Hariss score, postoperative complications and other aspects in the treatment of elderly intertrochanteric fractures with PFNA and InterTAN. To evaluate and discuss the curative effect of two kinds of intramedullary fixation for clinical reference。2. By gathering clinical data comparison PFNA and difference of InterTAN in clinical therapeutic effect, to test the line with this Meta data analysis results.Methods:1.Making inclusion and exclusion criteria, outcome measures.RCTs or quasi-RCTs pubilished in Chinese and English were retrieved by computer from Medline, EMBase, PubMed,Cochrane Library, FEBM, FMIS(From 2005 to January 2016) and CNKI.CBM, Weipu Database, Wanfang China Disserttion Database(CDDB) (From 2005 to January 2016) by two reviewers. We search international clinical trials registry platform (WHO ICTRP), clinical trials databases (ClinicalTrials.gov Detabase), the Chinese clinical trial registries (ChiCTR) to look for ongoing research. By Ovid Technologies database, China National knowledge infrastructure engineering (CNKI), Journal of Chinese academic conference papers (CACP), Wanfang dissertations of China database (CDDB) to retrieve bones and trauma Conference archives, not unpublished theses and dissertations and other grey literature.Two reviewers independently assess the quality of literature that were selected in accordance with the formulation of the standard. Data analysis was conducted in manager Review (version 5.3.5) software。2. From November 2013 to October 2015. PFNA and InterTAN in treating intertrochanteric fractures of 40 patients were retrospectively analyzed in department of Orthopaedics,The first affiliated hospital of Kunming Medical University. PFNA 22 cases, InterTAN 18 cases。records the Group indices such as operation time and bleed, indicators such as Harris score 6 months after surgery and complications. Data analysis using SPSS 23 software.Results:1.Finally, there were 10 literatures include in this study, including 3 literature in English and 9 literatures in Chinese. There were 339 patients by the treatment of PFNA and 325 patients by the treatment of InterTAN.Modified Jadad Rating Scale assessment:2 literatures were high quality and 8 literatures were low quality.The Cochrane Collaborations Tool For Assessing Risk Of Bias assessment:1 literature were low risk of bias and 9 literatures were low risk of bias. Data from the included literature was analyzed using RevMan. The results were as follows:there were statistical difference in Operation time, intraoperative blood loss (P<0.05); between the PFNA group and the InterTAN group,no statistical difference was found in Time to full weight bearing,fracture healing time, hip Hariss score, postoperative complications.(P>0.05).2. (1) There was no significant difference in the sex distribution, age and fracture pattern between the PFNA group and the InterTAN group (P>0.05)。(2) PFNAgroup and Inter Tan system operation time, intraoperative blood loss mean variance was 52.82±6.912and65.94±7.042,152.27±11.52andl85±16.179, the comparison between the two groups, P<0.05, the difference was statistically significant.。(3) PFNA group and InterTAN Harris scores mean variance was 83.218±3.98 and 82.700±2.93, between the two groups, P>0.05, the difference was no statistically significantcConclusion:1. The Meta-anaiysis provided evidence that for the treatment of intertrochanteric fractures in the elderly with PFNA or InterTAN,there were no statistical difference was found in Time to full weight bearing,fracture healing time, hip Harris score, postoperative complications.(P>0.05).According to Meta-analysis:InterTAN group was longer than PFNA group in the operative time, InterTAN group was more than PFNA group in intraoperative bleeding。2. (1) Compare with InterTan, PFNA has the advantages of simple operation, shorter operation time, less blood loss, but no no difference in hip Harris score, which is consistent with the results of Meta analysis in the first part. (2) PFNA and InterTan have a good internal fixation effect, the operation should be based on their design characteristics, biomechanics, individual treatment, in order to obtain the best treatment effect.