| Objective: Meta-analysis was used to evaluate the efficacy of proximal femoral nail anti-rotation(PFNA)in the treatment of intertrochanteric fractures of femur(IFF)in the supine and lateral positions.Methods: The database of Pubmed database,Embase database,Cochrane database,China Knowledge Network,Wanfang database,and VIP database were searched."PFNA" "intertrochanteric hip fractures" "intertrochanteric fractures" "supine position""lateral position" "intertrochanteric fractures" "position" "traction table" were combined as a subject or keyword in English."Proximal proximal anti-rotation nail" "anti-rotation proximal femoral nail" " intertrochanteric fractures of femur " " intertrochanteric fractures of femur " "supine position" "lateral position" "post position" The traction bed" and the like were combined as a keyword or subject in Chinese.The deadline was November 2018.RevMan 5.3 was used to calculate and analyze the data.Results: 11 randomized controlled trials(RCTs)involving a total of 1018 patients were included.Among them,there were 512 cases in the supine position with the help of traction bed and there were 506 cases in the lateral manual traction in the other group.The results of the meta-analysis showed that the operative time was significantly different between the two groups.The lateral position group was shorter than the supine position group,and the subgroup analysis included the normal people [MD=-12.07,95% CI(-18.28,-5.86),Z =3.81,P=0.0001] and the obese people [MD=-71.17,95%CI=(-137.10,-5.24),Z=2.12,P=0.03];setup time: [MD=-2.85,95% CI(-3.91,-1.80),Z=5.30,P <0.00001].There was significantly different between the two groups.The lateral position group was shorter than the supine position group;intraoperative fluoroscopy time: [SMD=-0.08,95% CI(-1.24,1.08),Z=0.14,P=0.89].There was no significant difference between the two groups;the length of the incision: [ SMD=-1.35,95% CI(-1.90,-0.79),Z=4.73,P<0.00001].There were significant differences betweenthe two groups.The lateral position group was shorter than the supine position group;intraoperative blood loss: There was significantly different between the two groups.The lateral position was lower than the supine position,and the subgroup analysis included the normal people [MD-24.64,95 %CI=(-40.89,-8.40),Z=2.97,P=0.003] and the obese people [MD=-35.23,95% CI(-63.58,-6.88),Z=2.44,P=0.01];time of hospital stay:[MD=-2.14,95% CI(-3.78,-0.50),Z=2.56,P=0.01].There was significantly different between the two groups.The lateral position was shorter than the supine position;time of starting load-bearing: [SMD=-0.29,95% CI(-0.75,0.18),Z=1.21,P=0.23].There was no significant difference between the two groups;fracture healing time:[SMD=-0.00,95% CI(-0.14,0.14),Z=0.04,P =0.97].There was no significant difference between the two groups;postoperative Harris values: [MD=3.98,95%CI=(-0.25,8.21),Z=1.85,P=0.06].There was no significant difference between the two groups;the postoperative functional excellence rate: [RR=1.01,95% CI(0.97,1.05),Z=0.59,P=0.55].There was no significant difference between the two groups;complications: [RR=0.64,95% CI(0.39,1.04),Z=1.80,P=0.07].There was no significant difference between the two groups.Conclusion: 1.When it comes to treatment of intertrochanteric fractures of femur with PFNA internal fixation,the lateral position is superior to the supine position in terms of the surgical time,preparation time,length of incision,intraoperative blood loss,time of hospital stay and so on;2.There is no significant difference between the two positions in the X-ray fluoroscopy time,time of starting load-bearing,fracture healing time,postoperative Harris values,postoperative excellent and good function rate,complications and other aspects;3.Although the lateral position has certain advantages,a variety of factors should be combined to select the most appropriate surgical position in clinical application. |
PDF Full Text Request