[Meta-analysis of the efficacy and safety of PFNA and InterTAN for the treatment of intertrochanteric fractures].

OBJECTIVE

To system evaluate the clinical effect and safety of PFNA and InterTAN 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 InterTAN for intertrochanteric fracture were collected from Cochrane Library(2017, issue 4), PubMed (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 RevMan 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), P<0.000 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 InterTAN could provide good effect for intertrochanteric fracture. The operation time of PFNA is shorter than that of InterTAN, 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 InterTAN. In patients with long life expectancy and high requirements, InterTAN may be preferentially selected to reduce complications. According to the patient's situation, after a comprehensive consideration, appropriate treatment can be selected.