Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (3): 477-485.doi: 10.3969/j.issn.2095-4344.2989
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Interlocking intramedullary nail for proximal femur versus proximal femoral anti-rotation intramedullary nail or proximal femoral anti-rotation intramedullary nail of Asian for intertrochanteric fractures in older adults: a meta-analysis
Liu Chang1, Han Shufeng2
- 1Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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Received:2020-03-20Revised:2020-03-25Accepted:2020-04-27Online:2021-01-28Published:2020-11-19 -
Contact:Han Shufeng, Master, Professor, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China -
About author:Liu Chang, Master, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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Liu Chang, Han Shufeng. Interlocking intramedullary nail for proximal femur versus proximal femoral anti-rotation intramedullary nail or proximal femoral anti-rotation intramedullary nail of Asian for intertrochanteric fractures in older adults: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(3): 477-485.
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2.1 检索结果 初检文献659篇，导入EndNote，使用软件和手工删除重复文献后纳入573篇，通过阅读文献标题、摘要后纳入28篇文献，阅读全文后纳入10篇文献，剔除评分低的文献，最终纳入8篇文献(图2)。其中包含7篇英文文献[4-10]，1篇中文文献[11]。"
2.2 纳入研究临床特征 见表1。"
2.3 文献质量评价结果 纳入的8篇研究中，2篇为随机对照研究[5，8]，6篇为队列研究[4，6-7，9-11]，4篇研究存在失访患者，均给出失访理由及人数[6，8-9，11]，1篇文章提到盲法[8]。随机对照研究Jadad评分均为高质量研究，队列研究NOS评分均>5分，见表2。"
2.4 Meta分析结果 2.4.1 两组手术时间差异的Meta分析结果 6篇研究报道了手术时间的比较[6-11]，其中Inter-TAN vs. PFNA内固定4篇[7，9-11]，Inter-TAN组457例，PFNA组463例，文献间存在异质性(Chi2=260.45，df=3，P < 0.000 01，I2=99%)，可以选择随机效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2篇[6，8]，Inter-TAN组132例，PFNA-Ⅱ组128例，文献间存在异质性(Chi2=6.45，df=1，P=0.01，I2=84%)，可以选择随机效应模型进行Meta分析。结果显示，Inter-TAN组手术时间长于PFNA-Ⅱ组[MD=-16.60，95%CI(-23.22，-9.99)，P < 0.05]，与PFNA组比较差异无显著性意义[MD=-7.24，95%CI (-16.03，1.55)，P=0.11]，见图3。"
2.4 Meta分析结果 2.4.1 两组手术时间差异的Meta分析结果 6篇研究报道了手术时间的比较[6-11]，其中Inter-TAN vs. PFNA内固定4篇[7，9-11]，Inter-TAN组457例，PFNA组463例，文献间存在异质性(Chi2=260.45，df=3，P < 0.000 01，I2=99%)，可以选择随机效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2篇[6，8]，Inter-TAN组132例，PFNA-Ⅱ组128例，文献间存在异质性(Chi2=6.45，df=1，P=0.01，I2=84%)，可以选择随机效应模型进行Meta分析。结果显示，Inter-TAN组手术时间长于PFNA-Ⅱ组[MD=-16.60，95%CI(-23.22，-9.99)，P < 0.05]，与PFNA组比较差异无显著性意义[MD=-7.24，95%CI (-16.03，1.55)，P=0.11]，见图3。"
2.4.2 两组术中透视时间差异的Meta分析结果 4篇研究报道了术中透视时间的比较[6-8，11]，其中Inter-TAN vs. PFNA内固定2篇[7，11]，Inter-TAN组151例，PFNA组160例,文献间存在异质性(Chi2=468.78，df=1，P < 0.000 01，I2=100%)，可以选择随机效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2篇[6，8]，Inter-TAN组132例，PFNA-Ⅱ组128例，文献间存在异质性(Chi2=87.34，df=1，P < 0.000 01，I2=99%)，可以选择随机效应模型进行Meta分析。结果显示，Inter-TAN组术中透视时间长于PFNA-Ⅱ组[MD= -1.85，95%CI(-2.53，-1.16)，P < 0.05]，与PFNA组比较差异无显著性意义[MD=-1.45，95%CI(-3.31，0.41)，P=0.13]，见图4。"
2.4.3 两组术中失血量差异的Meta 分析结果 6 篇研究报道了术中失血量的比较[6-11]，其中Inter-TAN vs. PFNA 内固定4 篇[7，9-11]，Inter-TAN组457 例，文献间存在异质性(Chi2=194.13，df=3，P < 0.000 01，I2=98%)，可以选择随机效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2 篇[6，8]，Inter-TAN组132例，文献间无明显异质性(Chi2=1.72，df=1，P=0.19，I2=42%)，可以选择固定效应模型进行Meta 分析。结果显示，Inter-TAN 组术中失血量与PFNA组比较差异均无显著性意义[MD=-23.08，95%CI(-54.74，8.58)，P=0.15]，多于PFNA-Ⅱ组[MD= -9.83，95%CI(-12.66，-6.99)，P < 0.000 01]，见图5。"
2.4.4 两组住院时间差异的Meta分析结果 4篇研究报道了住院时间的比较[6-9]，其中Inter-TAN vs. PFNA内固定2 篇[7，9]，Inter-TAN组246例，文献间无异质性(Chi2=0.05，df=1，P=0.82，I2=0%)，可以选择固定效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2篇[6，8]，Inter-TAN组132例，PFNA-Ⅱ组128例，文献间存在异质性(Chi2=6.05，df=1，P=0.01，I2=83%)，可以选择随机效应模型进行Meta分析。结果显示，Inter-TAN住院时间与PFNA组、PFNA-Ⅱ组比较差异均无显著性意义[MD=-0.26，95%CI (-0.59，0.07)，P=0.13；MD=-0.72，95%CI(-1.47，0.03)，P=0.06]，见图6。"
2.4.5 两组术后螺钉切出差异的Meta分析结果 8篇研究报道了术后螺钉切出的比较[4-11]，其中Inter-TAN vs. PFNA内固定5篇[5，7，9-11]，Inter-TAN组493例，PFNA组496例，文献间无异质性(Chi2=1.52，df=4，P=0.82，I2=0%)，可以选择固定效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定3篇[4，6，8]，Inter-TAN组182例，PFNA-Ⅱ组178例，文献间无异质性(Chi2=1.12，df=2，P=0.57，I2=0%)，可以选择固定效应模型进行Meta分析。结果显示，Inter-TAN组术后螺钉切出发生少于PFNA组、PFNA-Ⅱ组[OR=6.47，95%CI(2.79，15.00)，P < 0.05；OR=5.88，95%CI(1.29，26.69)，P < 0.05]，见图7。"
2.4.6 两组术后髋部或大腿疼痛差异的Meta分析结果 4篇研究比较了术后髋部或大腿疼痛[6-9]，其中Inter-TAN vs. PFNA内固定2篇[7，9]，Inter-TAN 组246例，PFNA组235例，文献间无异质性(Chi2=0.09，df=1，P=0.76，I2=0%)，可以选择固定效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2篇[6，8]，Inter-TAN组132例，PFNA-Ⅱ组128例，文献间无异质性(Chi2=0.04，df=1，P=0.85，I2=0%)，可以选择固定效应模型进行Meta分析。结果显示，Inter-TAN组髋部或大腿疼痛发生少于PFNA组、PFNA-Ⅱ组[OR=2.57，95%CI(1.19，5.52)，P < 0.05；OR=3.20，95%CI(-1.56，6.55)，P < 0.05]，见图8。"
2.4.7 两组术后股骨干骨折发生率差异的Meta分析结果 5篇研究报道了术后股骨干骨折的比较[6，8-11]，其中Inter-TAN vs. PFNA内固定3篇[9-11]，Inter-TAN组355例，PFNA组367例，文献间无异质性(Chi2=0.10，df=2，P=0.95，I2=0%)，可以选择固定效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2篇[6，8]，Inter-TAN组132例，PFNA-Ⅱ组128例，文献间无异质性(Chi2=0.31，df=1，P=0.58，I2=0%)，可以选择固定效应模型进行Meta分析。结果显示，Inter-TAN组术后股骨干骨折发生率少于PFNA组、PFNA-Ⅱ组[OR=3.87，95%CI(1.75，8.57)，P < 0.05；OR=7.06，95%CI(1.24，40.07)，P < 0.05]，见图9。"
2.4.8 两组术后二次手术发生率差异的Meta分析结果 6篇研究报道了术后二次手术的比较[4-5，7-10]，其中Inter-TAN vs. PFNA内固定4篇[5，7，9-10]，Inter-TAN组444例，PFNA组432例，文献间无异质性(Chi2=3.05，df=3，P=0.38，I2=2%)，可以选择固定效应模型进行Meta分析；Inter-TAN vs. PFNA-Ⅱ内固定2篇[4，8]，Inter-TAN组107例，PFNA-Ⅱ组106例，文献间无异质性(Chi2=1.04，df=1，P=0.31，I2=4%)，可以选择固定效应模型进行Meta分析。结果显示，Inter-TAN组术后二次手术发生率少于PFNA组[OR=4.10，95%CI(2.45，6.86)，P < 0.05]，与PFNA-Ⅱ组比较差异无显著性意义[OR=3.19，95%CI(0.84，12.08)，P=0.09]，见图10。"
2.4.9 两组术后Harris 评分差异的Meta分析结果 8篇研究报道了术后Harris评分的比较[4-11]，其中Inter-TAN vs. PFNA内固定5篇[5，7，9-11]，Inter-TAN组493例，PFNA组496例，文献间无异质性(Chi2=3.69，df=4，P=0.45，I2=0%)，可以选择固定效应模型进行Meta分析(结果无差异)；Inter-TAN vs. PFNA-Ⅱ内固定3篇[4，6，8]，Inter-TAN组182例，PFNA-Ⅱ组178例，文献间存在异质性(Chi2=6.28，df=2，P=0.04，I2=68%)，可以选择随机效应模型进行Meta分析。结果显示，Inter-TAN组术后Harris评分与PFNA组、PFNA-Ⅱ组比较差异均无显著性意义[MD=-0.19，95%CI(-0.98，0.60)，P=0.63；MD=0.01，95%CI(-3.09，3.11)，P=1.00]，见图11。"
2.4.10 两组头钉尖顶距差异的Meta 分析结果 6 篇研究报道了头钉尖顶距的比较[4，6-10]，其中Inter-TAN vs. PFNA内固定3 篇[7，9-10]，Inter-TAN 组408 例，PFNA 组399 例，文献间存在异质性(Chi2=17.82，df=2，P < 0.05，I2=89%)，可以选择随机效应模型进行Meta 分析；Inter-TANvs PFNA-Ⅱ内固定3 篇[4，6，8]，Inter-TAN 组182 例，PFNA-Ⅱ组178 例，文献间存在异质性(Chi2=180.31，df=2，P < 0.05，I2=99%)，可以选择随机效应模型进行Meta分析。结果显示，Inter-TAN 组头钉尖顶距与PFNA 组、PFNA-Ⅱ组比较差异均无显著性意义[MD=-0.17，95%CI(-0.81，0.47)，P=0.60；MD=0.15，95%CI (-4.57，4.86)，P=0.95]，见图12。"
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