Meta Analysis Of The Effect Of Artificial Femoral Head Replacement And PFNA Internal Fixation On Intertrochanteric Fractures In The Elderly

Objectives We compared the surgical effects,postoperative recovery and incident complications of Inter Tan nail,proximal femoral nail anti-rotation(PFNA)and artificial femoral head replacement in the treatment of intertrochanteric fractures in a metaanalysis to confirm the characteristics and application of the three treatment approaches.Methods We searched China Biology Medicine disc,Wanfang,China National Knowledge Internet,medline,Pubmed to select relevant papers published from January2009 to December 2019 about the efficacy of PFNA,Inter Tan and artificial femoral head replacement in the treatment of intertrochanteric fractures.We used duration of the procedure,blood loss,blood transfusion,amount of post-operation drainage,complications,partial weight-bearing time,VAS score,Harris score,length of hospital stay,healing time,perspective time,hip pain and shortening of femoral neck as observation indexes,combined with exclusion and inclusion criteria,to screen papers that meets the requirements from the retrieved ones.The data were extracted and analyzed by Review Manager 5.3 software.Results 1 There were 9 papers comparing InterTan nail with PFNA in the treatment of intertrochanteric fractures through duration of the procedure,blood loss,healing time.,perspective time,complications,partial weight-bearing time,hip pain,Harris score,length of hospital stay and shortening of femoral neck.We found that PFNA was superior to Inter Tan in terms of duration of the procedure,blood loss,perspective time and length of hospital stay and that Inter Tan had more advantages than PFNA in terms of hip pain and shortening of femoral neck;however,there was no statistical difference between the two surgical methods in the healing time,complications and partial weight-bearing time.2 There were 10 papers comparing PFNA with the artificial femoral head replacement in the treatment of intertrochanteric fractures through duration of the procedure,blood loss,intraoperative and postoperative blood transfusion,amount of post-operation drainage,complications,partial weight-bearing time,Harris score(6 months,1 year,2 years),and length of hospital stay.We concluded that PFNA was significantly better than artificial femoral head replacement in terms of duration of the procedure,blood loss,blood transfusion,postoperative drainage volume and Harris score(1 year after surgery,2 years after surgery)and that the partial weight-bearing time was longer in artificial femoral head replacement than in PFNA;however,there was no statistical difference between the two surgical methods in the comparison of complications,VAS score,Harris score(6months after surgery)and length of hospital stay.3 There were 10 papers comparing Inter Tan with the artificial femoral head replacement in the treatment of intertrochanteric fractures through duration of the procedure,blood loss,blood transfusion,complications,postoperative partial weight-bearing time,Harris score,and the length of hospital stay.We found that Inter Tan was significantly superior to the artificial femoral head replacement in operation time,blood loss and blood transfusion and that the artificial femoral head replacement group has more advantages when compared with the partial weight-bearing time and the length of hospital stay;however,there was no significant difference between the two surgical methods in terms of complications and Harris score(1 year after surgery).Conclusions 1 Both PFNA and Inter Tan can achieve good clinical efficacy in the treatment of intertrochanteric fractures in the elderly.2 PFNA is preferred for the elderly with poor body tolerance and osteoporosis and Inter Tan for patients with good bone condition,body tolerance and high weight-bearing requirements in the early.3 The results of our study didn't think hemiarthroplasty replacement as the first choice.4However,for the elderly with severe osteoporosis,accidents such as fracture end collapse and intramedullary nail cutting often occur.Therefore,artificial femoral head replacement is a better choice,and the recovery time of daily walking is faster,which is more convenient for the daily life of patients.Figure 28;Table 9;Reference 112...