PFNA与InterTAN治疗股骨转子间骨折的疗效与安全性的Meta分析  

Meta analysis of the efficacy and safety of PFNA and Inter TAN for the treatment of intertrochanteric fractures

作　　者：石俊俊[1] 王宇泽[1] 李渊[1] 高远鹏[1] 王栋[1] 王智勇[1] 张志强[1] SHI Jun-jun WA NG Yu-ze LI Yuan GAO Yuan-peng WANG Dong WANG Zhi-yong and ZHA NG Zhi-qiang.(Dep artme nt of Or- thopaedics ,the Second Hospital of Shanxi Medical University, Taiyuan 030001 ,Shanxi, China)

机构地区：[1]山西医科大学第二医院骨科,山西太原030001

出　　处：《中国骨伤》2017年第10期933-939,共7页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金(编号:31300802);山西医科大学第二医院博士基金(编号:20120407)~~

摘　　要：目的:系统评价PFNA和Inter TAN治疗股骨转子间骨折的疗效与安全性。方法:按照Cochrane系统评价的方法,计算机检索Cochrane图书馆(2017年第4期),Pub Med(2003年1月至2017年5月),万方医学网(2003年1月至2017年5月),中国期刊全文数据库(2003年至2017年5月),收集采用PFNA和Inter TAN内固定治疗股骨转子间骨折的所有前瞻性随机和半随机对照临床试验。由两名评价者分别对纳入研究进行独立的质量评价和数据提取后进行交叉核对,采用Rev Man 5.3软件进行Meta分析。结果:共纳入2篇随机对照试验和5篇半随机对照试验,共611例。结果显示,两种内固定方式在Harris评分[MD=-1.00,95%CI(-2.29,0.28),P=0.13]、骨折愈合时间[MD=0.04,95%CI(-0.70,0.77),P=0.92]、完全负重时间[MD=1.06,95%CI(-0.29,2.42),P=0.13]、住院时间[MD=-0.04,95%CI(-0.52,0.45),P=0.89]及切口长度[MD=-1.00,95%CI(-2.64,0.65),P=0.23]方面差异无统计学意义。两种内固定方式在手术时间[MD=-25.75,95%CI(-37.47,-14.03),P<0.000 1],术中失血量[MD=-55.67,95%CI(-108.07,-3.27),P=0.04]和内固定并发症发生率[MD=4.17,95%CI(1.33,13.08),P=0.01]方面差异有统计学意义。结论:PFNA与Inter TAN治疗股骨转子间骨折均能取得很好的效果。PFNA的手术时间较Inter TAN短,术中失血量少,在合并症多、不能耐受较长时间手术的患者中,可优先选择PFNA。而PFNA的内固定并发症较Inter TAN多,在预期寿命长、要求高的患者中可优先选择Inter TAN以减少并发症。需对患者的情况进行全面综合考虑后再行制定具体治疗方案。Objective：To system evaluate the clinical effect and safety of PFNA and Inter TAN internal fixation methods for femoral intertrochanteric fracture. Methods：According to the Cochrane systemic analysis method,randomized controlled trials and quasi randomized controlled trials which were about the comparison of PFNA and Inter TAN for intertrochanteric fracture were collected from Cochrane Library（2017,issue 4）,Pub Med（January,2003-May,2017）,Wanfang Med Online（January,2003-May,2017） and China Academic Journals Full text Database（January,2003-May,2017） by computer searching. Cross checking was done after assessing the quality of the included trials and extracting the data by two reviewers independently. Data analysis were performed with Rev Man 5.3. Results：Two randomized controlled trials and five quasi randomized controlled trials involving 611 cases met the inclusion criteria. The meta analyses showed no significant differences between the two methods on Harris scores [MD=-1.00,95%CI（-2.29,0.28）,P=0.13],union time [MD=0.04,95%CI（-0.70,0.77）,P=0.92],full weight bearing time [MD=1.06,95%CI（-0.29,2.42）,P =0.13],hospital stay [MD =-0.04,95%CI（-0.52,0.45）,P=0.89] and length of incision [MD =-1.00,95% CI（-2.64,0.65）,P =0.23]. There were significant differences between the two methods on operative time [MD=-25.75,95%CI（-37.47,-14.03）,P0.000 1],intraoperative blood loss[MD=-55.67,95%CI（-108.07,-3.27）,P=0.04] and the internal fixation complication rate [MD=4.17,95%CI（1.33,13.08）,P=0.01]. Conclusions：Both PFNA and Inter TAN could provide good effect for intertrochanteric fracture. The operation time of PFNA is shorter than that of Inter TAN,and there is less blood loss during operation. PFNA may be the first choice for the treatment of patients who have many complications and can＇t endure long time operation. The complications of PFNA are more than those of Inter TAN. In patients with long life expectancy and high requirements,Inter TAN may be preferentially selected

关 键 词：股骨转子间骨折 骨折固定术 内 META分析 

分 类 号：R683.42[医药卫生—骨科学]