| Backgroud:With the accelerated aging of the population in China,the elderly population is increasing,and the elderly population is a high incidence of intertrochanteric fractures.Older patients are often accompanied by a variety of medical conditions before the injury,in order to restore the patient’s function to the pre-fracture as soon as possible.Active state,currently advocates early surgical treatment.Due to the different medical conditions in different regions of the country,the level of doctors and surgical practices at different levels of hospitals are different,so there are many surgical methods in the country.The proximal femoral nails and artificial femoral head replacement are more commonly used to treat intertrochanteric fractures in the elderly in China.The patient,but which method is better,is inconclusive.Objective:This study aimed to compare the efficacy of proximal femoral nail and artificial femoral head replacement in elderly femoral intertrochanteric fractures in China by meta-analysis Methods:The data of CNKI,Wanfang Database,Sinomed,Chinese biomedical network,Vip database,Pubmed database,Cochrane Library,Embase and other databases were searched.A clinical control trial of the Proximal Femoral Nail Antirotation and artificial femoral head replacement for the treatment of intertrochanteric fracture of the femur in the past four years was investigated.the Chinese Keywords: Proximal Femoral Nail Antirotation(PFNA),femoral head replacement,random;the English Keywords: "PFNA","Proximal Femoral Nail Antirotation","Arthroplasty,Replacement,Hip" and "Hip fracture".The included literature data are analyzed by Rev Man 5.30.Results:A total of 13 controlled trials are included,of which 8 are randomized controlled trials and 5 are retrospectively studied.A total of 902 elderly patients with intertrochanteric fractures are enrolled.There are 464 cases of PFNA group and 438 cases of artificial femoral head replacement group.The results of The meta-analysis showed that the AFHR have a longer operation time with a statistically significant difference compared with PFNA [SMD = 3.58,95% CI(3.25,3.91),P <0.00001] intraoperative blood loss is more,and the difference was statistically significant[SMD = 3.41,95%CI(2.90,3.92),P <0.00001];earlier out of bed,the difference is statistically significant [SMD =-1.94,95% CI(-3.70,-0.19),P =0.03];There is no significant difference in hip harris score at one year after surgery[SMD =-0.08,95%CI(-0.28,0.12,)P =0.42];there is no significant difference in postoperative complications [SMD = 1.14,95% CI(0.81,1.6),P = 0.45];There is no significant difference in postoperative medical complications [SMD = 0.89,95% CI(0.57,1.37),P = 0.59].conclusion:In the treatment of femoral intertrochanteric fractures in the elderly,artificial femoral head replacement is more advantageous in early ambulation,while the proximal femoral nail is more effective in the operation time and intraoperative blood loss.postoperative long-term hip joint function,postoperative overall complications,and postoperative medical complications are not significantly different.The surgeon should use appropriate surgical procedures based on the patient’s condition,the specific condition and the surgeon’s surgical proficiency... |
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