| Objective: A single-center retrospective study and Meta-analysis of the clinical efficacy of cementless Femoral Head Replacement(FHR)versus Proximal Femoral Nail Anti-rotation(PFNA)in the treatment of senile unstable intertrochanteric fractures,to probe into the characteristics,surgical indications and technical points of cementless FHR and PFNA in the treatment of senile unstable intertrochanteric fractures,in order to provide a reference for the choice of clinical applications.Methods: 1.Retrospective analysis of clinical and follow-up data from January 2012 to December 2017 of surgically treated patients with unstable intertrochanteric fractures over 75 years of age in the 940 th Hospital of Joint Logistics Support Force of People's Liberation Army(Former PLA Lanzhou General Hospital),according to the surgical method,they were divided into: FHR group and PFNA group.Develop inclusion and exclusion criteria,collect baseline data from patients enrolled,including: age,gender,cause of injury,fracture side,fracture classification,osteoporosis singh index classification,American Society of Anesthesiologists(ASA)and combined medical diseases;Perioperative indicators,including: length of incision,time of operation,obvious and hidden blood loss,bed rest time,length of hospital stay,weight-bearing time after surgery,visual analog scale(VAS),postoperative complications occurrence,the Harris hip function score and excellent rate.Statistical analysis was performed on the collected data using the SPSS statistical software package.2.Computer search for Cochrane Library,MEDLINE,PubMed,Ovid,EMBASE,CBM,CNKI,Articles,VIP and other databases from the establishment to the December 2019 related literature,manual search of Chinese and orthopedic journals for nearly 5 years of relevant literature,screening for the clinical controlled trial of FHR and PFNA treatment for senile unstable intertrochanteric fractures,strictly evaluate the methodological quality of the included studies,data such as length of surgical incision,operation time,intraoperative blood loss,postoperative bed time,length of hospital stay,weight-bearing time after surgery,,postoperative complication rate,and the Harris hip function score were collected,Meta analysis was performed using RevMan 5.3 provided by the Cochrane Collaboration.Results: 1.206 eligible patients were included finally,including 99 in the FHR group and 107 in the PFNA group,The average age of the patients was 84.1 years,114 males and 92 females,according to the Evans-Jensen classification: 91 cases of type III,88 cases of type IV,and 27 cases of type V,Osteoporosis Singh index classification: 50 cases of grade V,58 cases of grade IV,46 cases of grade III,32 cases of grade II,20 cases of grade I,ASA classification: 45 cases of grade I,99 cases of grade II,62 cases of grade III,149 cases were combined with basic diseases among them,there was no significant difference in baseline data between the two groups(P>0.05),which was comparable.The FHR group was superior to the PFNA group in terms of postoperative bed time,weight-bearing time after surgery and postoperative complications,the difference was statistically significant(P<0.05),the PFNA group was superior to the FHR group in terms of length of surgical incision,average operation time,obvious and hidden blood loss,the difference was statistically significant(P<0.05),there was no significant difference in length of hospital stay and postoperative VAS score between the two groups(P>0.05);The Harris score and excellent rate of hip function in the FHR group were higher than those in the PFNA group at 3 and 6 months after operation(P<0.05),but there was no significant difference in hip function score and excellent rate between the two groups at 12 months after operation(P>0.05).2.Finally 12 articles with composite requirements were included,a total of 1068 patients.Meta-analysis showed that the length of surgical incision[MD= 5.28,95%CI(4.29,6.28),P<0.00001 ],operation time[ MD= 17.64,95%CI(13.19,22.09),P<0.00001 ],intraoperative blood loss[MD= 110.55,95%CI(86.22,134.89),P<0.00001],in FHR group were larger than that in PFNA group,but postoperative bed time[MD=-12.56,95%CI(-18.66,-6.45),P<0.00001],length of hospital stay[MD=-3.40,95%CI(-5.96,-0.83),P=0.01]and weight-bearing time after surgery[MD=-33.29,95%CI(-49.05,-17.54),P<0.00001]are shorter,the hip function score was high at 1 month[MD =18.72,95%CI(13.82,23.63),P <0.00001],3 months[MD =12.56,95%CI(9.63,15.48),P <0.00001],and 6 months[MD =5.94,95%CI(4.63,7.25),P <0.00001] after surgery,and the incidence of postoperative infection complications was low[OR = 0.54,95% CI(0.32,0.94),P = 0.03].There was no significant difference in hip function Harris score and other complications between the 12 months after surgery(P>0.05).Conclusions: 1.A single-center retrospective study concluded that cementless FHR has the advantages of short postoperative bed time,early weight-bearing time after surgery,low postoperative complication rate,and early recovery of hip function,but the surgical incision is large,the operation time is long,obvious and hidden blood loss are more.2.Meta-analysis findings: cementless FHR is superior to PFNA in terms of postoperative bed rest time,length of hospital stay and postoperative weight-bearing time,postoperative infection complication rate,and hip function scores at 1,3,and 6 months,but there is no PFNA ideal in terms of length of surgical incision,operation time and blood loss during surgery.3.Both cementless FHR and PFNA have their own characteristics,which are effective ways to treat senile unstable intertrochanteric fractures.They can be applied according to specific conditions,under the premise of strict grasp of indications,cementless FHR is also a treatment option for senile unstable intertrochanteric fractures. |
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