Proximal femoral nail anti-rotation and locking plate for treating femoral intertrochanteric fractures:a systematic review / 中国组织工程研究

ABSTRACT

BACKGROUND:Proximal femoral locking plate and proximal femoral nail anti-rotation are the two common methods for the treatment of femoral intertrochanteric fractures in clinic. However, there were few randomized control ed trials on the comparison of both methods. Most of them are retrospective case analysis, and short of systematic evaluation. OBJECTIVE:To systematical y evaluate the clinical outcomes and safety between locking compression plate and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures. METHODS:The Cochrane Library (No.2 in 2015), PubMed(1966-01/2015-06), MEDLINE (1966-01/2015-06), EMbase (1984-01/2015-06), CNKI (1979-01/2015-06), VIP(1989-01/2015-06)and WanFang Data(1990-2015)were searched by computer. Meanwhile, relevant literature from the relevant journals and references were searched by hand. Al the randomized control ed trials concerning locking compression plate and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures were col ected. The literature was strictly filtered out according to the inclusion criteria, and was strictly evaluated for the quality. Meta-analysis on the included results was performed with RevMan5.2 software from the Cochrane col aboration. RESULTS AND CONCLUSION:There were 54 potential y relevant papers, and final y, 11 randomized control ed trials were eligible for this investigation. A total of 917 patients were included containing locking compression plate group (464 cases), proximal femoral nail anti-rotation group (453 cases). The Meta-analysis results showed that there were no significant differences in Harris scores, excel ent rate, complications, fracture healing time and hospital stays after treatment between the locking compression plate and proximal femoral nail anti-rotation groups. However, there were significant differences in the time of operation [MD=15.80,95%CI(7.57-24.04), P=0.000 2], peri-operative blood loss [MD=98.01, 95%CI(58.57-137.44),P<0.01], ambulation loading time [MD=8.07,95%CI(3.02-13.12),P=0.002], the length of incision [MD=6.90,95%CI(1.07-12.73), P=0.02] and postoperative drainage volume [MD=41.85,95%CI(23.77-59.93),P<0.01]. These results suggest that the treatment of proximal femoral nail anti-rotation had shortened the length of incision and the time of operation. The treatment of locking compression plate took more time of ambulation loading time, more peri-operative blood loss and postoperative drainage volume. Because the number of cases which this study included are few, and the fol ow-up time was shorter, we should design stricter large sample randomized control ed studies in future increase the strength of the evidence by conducting medium and long-term fol ow-up.