Introduction

There is no consensus regarding the superiority between intramedullary nailing and primary arthroplasty in the management of intertrochanteric femoral fractures. This systematic review was performed to investigate and compare the clinical efficacy of intertrochanteric femoral fractures treated with these 2 methods.

Materials and methods

We systematically searched PubMed, Embase, Cochrane, Web of science core collection and ClinicalTrials.gov for randomized controlled trials which compared the clinical outcomes of intertrochanteric fractures treated with either intramedullary nails or primary arthroplasty. Relevant data of the postoperative complications, reoperations, mortality and functional assessment, were pooled and presented graphically.

Results

A total of 6 trials with 427 participants were identified and included in the analyses. The pooled estimates suggested these 2 techniques have comparable risks in terms of overall complications (pooled risk ratio [RR] .80; 95% confidence interval [CI] .43 to 1.43; I² = 79.94%), the rate of patients with orthopedic complications (RR .71, 95% CI .40 to 1.27; I² = .00%), reoperations (RR 1.33, 95% CI .48 to 3.71; I² = .00%), the overall mortality (RR .52; 95%CI .26 to 1.02; I² = 31.35%) and 1-year mortality (RR .67; 95%CI .38 to 1.19; I² = .00%). Primary arthroplasty associated with higher HHS at 3 months postoperatively (MD -21.95, 95% CI -28.29 to −15.60; I² = 70.44%). While the difference was not significant at 6 months (MD 2.32, 95% CI -1.55 to 6.18; I² = .00%), and even reversed at 12 months postoperatively (MD 13.02, 95% CI 8.14 to 17.90; I² = 73.42%).

Conclusions

Meta-analytic pooling of current evidences demonstrated that primary arthroplasty is related to a better early functional recovery at the early stage postoperatively, but the long-term result tends to favor to intramedullary nailing. The differences in overall complications, the rate of patients with orthopedic complications, reoperations, overall and 1-year mortality did not reach a significant level.

中文翻译：

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髓内钉还是初次关节成形术？基于随机对照试验的股骨粗隆间骨折预后的系统评价和荟萃分析

介绍

在股骨粗隆间骨折的治疗中，髓内钉与初次关节置换术之间的优越性尚未达成共识。本系统评价旨在调查和比较这两种方法治疗股骨粗隆间骨折的临床疗效。

材料和方法

我们系统地搜索了 PubMed、Embase、Cochrane、Web of science 核心合集和 ClinicalTrials.gov 的随机对照试验，这些试验比较了使用髓内钉或初次关节成形术治疗的转子间骨折的临床结果。合并术后并发症、再手术、死亡率和功能评估的相关数据并以图形方式呈现。

结果

共确定了 6 项试验，有 427 名参与者，并将其纳入分析。汇总估计表明，这两种技术在总体并发症（汇总风险比 [RR] .80；95% 置信区间 [CI] .43 至 1.43；I ² = 79.94%）、骨科患者发生率方面具有可比性风险并发症（RR .71，95% CI .40 至 1.27；I ² = .00%），再次手术（RR 1.33，95% CI .48 至 3.71；I ² = .00%），总死亡率（RR .52 ；95%CI .26 至 1.02；I ² = 31.35%）和 1 年死亡率（RR .67；95%CI .38 至 1.19；I ² = .00%）。初次关节成形术与术后 3 个月较高的 HHS 相关（MD -21.95, 95% CI -28.29 至 -15.60；I ²= 70.44%）。虽然差异在 6 个月时不显着（MD 2.32，95% CI -1.55 至 6.18；I ² = .00%），甚至在术后 12 个月时逆转（MD 13.02，95% CI 8.14 至 17.90；I ² = 73.42%）。

结论

目前证据的荟萃分析表明，初次关节成形术与术后早期更好的早期功能恢复有关，但长期结果倾向于髓内钉。总体并发症、骨科并发症患者发生率、再手术率、总体死亡率和1年死亡率的差异均未达到显着水平。