A meta-analysis of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty for intertrochanteric fractures in the elderly

doi:10.3969/j.issn.2095-4344.2015.31.026

Abstract

Abstract:

BACKGROUND: The methods to treat intertrochanteric fracture are controversial. A large number of clinical
studies concern the therapeutic effects of several popular methods to repair intertrochanteric fracture, but these results lack of independence, and may have bias that cannot be measured in the variable and observational studies. Thus, relevant studies have been limited.
OBJECTIVE: To compare the repair effects of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty on intertrochanteric fracture in aged patients by meta-analysis.
METHODS: Four electronic databases were searched, including Cochrane library, PubMed, Web of Science and Chinese BioMedical Literature Database, to collect all randomized controlled trials concerning the treatment of intertrochanteric fractures in the elderly with proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty. Using meta-analysis of evidence-based medicine, X-ray exposure time, postoperative complication rate, postoperative bed time, postoperative wound infection rate, Harris hip scores, mean operation time, intraoperative blood loss, length of hospital stays and length of the incision were compared and evaluated. Standard and methodology quality of the trials were critically assessed and relative data were extracted. This study used the Review Manager 5.0 software provided by Cochrane collaboration network.
RESULTS AND CONCLUSION: Twelve randomized controlled trials with 1 454 patients were included. Significant differences in mean operation time, intraoperative blood loss, X-ray exposure time, postoperative complication rate, and postoperative bed time were detected between the proximal femoral nail anti-rotation and dynamic hip screw groups (P < 0.05). Significant differences in length of hospital stays, postoperative complication rate, and postoperative bed time were observed between the proximal femoral nail anti-rotation and total hip arthroplasty groups (P < 0.05). Significant differences in postoperative complication rate, postoperative bed time, and Harris hip scores were detectable between the dynamic hip screw and total hip arthroplasty groups (P < 0.05). These data confirm that proximal femoral nail anti-rotation was apparently better than dynamic hip screw and total hip arthroplasty in operation time, intraoperative blood loss, length of hospital stays, postoperative complication rate, and postoperative bed time. Dynamic hip screw was better than proximal femoral nail anti-rotation in X-ray exposure time. Total hip arthroplasty was better than dynamic hip screw and proximal femoral nail anti-rotation in length of hospital stays, postoperative complication rate and postoperative bed time.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Fractures, Bone Nails, Internal Fixators, Arthroplasty, Replacement, Hip, Meta-Analysis

CLC Number:

R318

Qiao Yong-jie, Cao Xue-fei, Zhang Lv-dan, Wang Qin-peng, Zhen Ping. A meta-analysis of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty for intertrochanteric fractures in the elderly [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(31): 5057-5064.

Figures/Tables 15

References

[1] Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis.Orthop Traumatol Surg Res. 2014;100(8): 859-866.
[2] Ranjeetesh K, Singh RN, Singh BN. Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur. J Clin Orthop Trauma. 2012;3(1): 28-36.
[3] 宋卫东,彭岳文,李德,等.老年股骨转子间骨折治疗:股骨近端髓内钉-螺旋刀片和人工关节置换的效果比较[J].中国组织工程研究与临床康复,2010,14(43):7999-8003.
[4] Tang PF, Hu FK, Shen J, et al. Proximal femoral nail antirotation versus hemiarthroplasty:A study for the treatment of intertrochanteric fractures. Injury. 2012;43(6):876-881.
[5] Li YJ, Li ZB,Yu WH,et al. Case-control study on dynamic hip screw and proximal femoral nail anti-rotation for the treatment of unstable intertrochanteric fractures in elderly patients. Zhongguo gu shang. 2013;26(12): 977-980.
[6] Shen GY. Effectiveness comparison of proximal femoral nail antirotation and dynamic hip screw for intertrochanteric fractures in the elderly patients. Zhongguo Xiufu Chongjian Waike Zazhi. 2012;26(6):671-674.
[7] Wang WY, Yang TF, Liu L, et al. A comparative study of ipsilateral intertrochanteric and femoral shaft fractures treated with long proximal femoral nail antirotation or plate combinations. Orthop Surg. 2012;4(1):41-46.
[8] Jadad AR, Moore RA, Carroll D, et al. Assessing the Quality of Reports of Randomized Clinical Trials: Is Blinding Necessary? Control Clin Trials. 1996; 17:1-12.
[9] Bhavwk G, Marimuthu K, Kumar V, et al. Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstabletrochanteric fractures. A randomised prospective comparative trial. Hip Int. 2011;21(5):531-536.
[10] Xu YZ, Geng DC, Mao HQ, et al. A Comparison of the Proximal Femoral Nail Antirotation Device and Dynamic Hip Screw in the Treatment of Unstable Pertrochanteric Fracture. J Int Med Res. 2010;38(4): 1266-1275.
[11] Zou J, Xu Y, Yang H. A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures. J Int Med Res. 2009;37(4):1057-1064.
[12] 黄小强,廖永华,王效东,等.关节置换与动力髋螺钉固定治疗高龄转子间骨折患者下肢功能恢复的比较[J].中国临床康复, 2006, 10(4):36-38.
[13] 武斌,梁杰,杜远立,等.髋关节置换与动力髋螺钉内固定治疗高龄股骨粗隆间骨折疗效观察[J]. 中国矫形外科杂志, 2012,20(20): 1900-1901.
[14] 杜向东,李涛,任飞,等.髋关节置换治疗高龄不稳定型股骨粗隆间骨折的临床效果观察[J]. 现代生物医学进展,2014,14(6): 1135-1138.
[15] 吴松,邹玮君,邓宇杰,等.不稳定型股骨粗隆间骨折行髋关节置换治疗的效果观察[J].当代医学,2014,20(7):40-41.
[16] 杨希亮. 髋关节置换和股骨近端髓内钉治疗粗隆间骨折的临床研究[J].中国医学创新,2013,10(22):125-127.
[17] 李世芳,熊灿,周道政. DHS与PFNA治疗老年股骨粗隆间骨折的比较[J].中国现代手术学杂志,2013,17(6):438-440.
[18] 米仕第. PFNA与DHS内固定术治疗不稳定性股骨粗隆间骨折疗效分析[J]. 黑龙江医学,2014,38(3):253-254.
[19] 陈昭心,梁伟,潘李德.PFNA与DHS治疗老年股骨粗隆间骨折的疗效比较[J].中国现代医生,2014,52(12):17-19.
[20] 伍旭辉. PFNA和THA治疗老年性股骨粗隆间骨折的临床观察[J].中国医药导报,2012,9(36): 85-86.
[21] Schipper IB, Marti RK, van der Werken C. Unstable trochanteric femoral fractures:extramedullary or intramedullary fixation. Review of literature. Injury. 2004; 35:142-151.
[22] Pu JS, Liu L, Wang GL, et al. Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients. Int Orthop. 2009;33(5):1441-1444.
[23] Chua IT, Rajamoney GN, Kwek EB. Cephalomedullary nail versus sliding hip screw for unstable intertrochanteric fractures in elderly patients. J Orthop Surg (Hong Kong). 2013; 21(3): 308-312.
[24] Stern MB, Angerman A. Comminuted intertrochanteric fractures treated with a Leinbach prosthesis. Clin Orthop Relat Res, 1987;(218):75-80.
[25] Haentjens P, Casteleyn PP, Opdecam P. Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg. 1994;60(Suppl 1):124-128.