Meta-analysis Of The Efficacy Of PFNA And Inter-TAN In The Treatment Of Unstable Intertrochanteric Fractures In The Elderly

ObjectiveBy means of meta-analysis,the clinical efficacy of Inter-TAN and PFNA in the treatment of senile unstable intertrochanteric fractureswas compared.MethodsCochrane,Embase,Pub Med,CNKI,Wanfang and VIP were manually searched by computer,and literatures related to inter-TAN and PFNA treatment of elderly unstable intertrochanteric fractures were collected.The retrieval time was established until January 2022.Two reviewers independently read and screened the literature,extracted data and evaluated the quality.Meta-analysis was performed using Rev Man 5.3 software.ResultsA total of 1843 patients were selected through strict screening,including 911 patients in the Inter-TAN group and 932 patients in the PFNA group.Meta-analysis results showed that: PFNA and Inter-TAN showed significant differences in fracture healing time {MD=0.07,95%CI（-0.39,0.53）,Z=0.3,P=0.76},complete weight-bearing time {MD=-0.35,95%CI（-0.273,0.03）,Z=1.91,P = 0.06},Harris score {MD = 0.58,95% CI（0.37,1.54）,Z = 1.20,P = 0.23),the length of time {MD = 0.14,95% CI（0.41,0.13）,Z = 1.02,P = 0.31),the spire {MD = 0.63,95% CI（2.13,0.86）,Z =0.83,P = 0.41} no statistically significant difference.In the screw cutout{OR = 6.35,95% CI（3.11,12.95）,Z = 5.08,P < 0.00001} {,femoral fractures OR = 4.08,95% CI（1.51,10.99）,Z = 2.78,P = 0.005),hip varus{OR = 4.93,95% CI（1.27,19.13）,Z = 2.01,P = 0.02} {,secondary surgery OR = 2.68,95% CI（1.45,4.95）,Z = 3.15,P=0.002},thigh pain{OR=3.94,95%CI（1.90,8.14）,Z=3.94,P=0.0002},the difference was statistically significant,and Inter-TAN performance was better than PFNA.In operation time {MD = 8.83,95% CI（12.8,4.86）,Z = 4.36,P = 0.0001),intraoperative blood loss,{MD = 30.02,95% CI（47.11,12.92）,Z = 3.44,P=0.0006},fluoroscopy time {MD=-1.2,95%CI（-2.04,-0.34）,Z=2.83,P=0.005} were statistically significant,and PFNA was better than Inter-TAN.ConclusionPFNA and Inter-TAN can achieve good clinical efficacy in the treatment of unstable femoral intertrochanteric fractures in the elderly.PFNA is suitable for patients with high surgical risk and poor physical function who require to complete the operation as soon as possible.Inter Tan is suitable for patients with good physical function and can tolerate long-term surgery.