Comparative outcome of PFNA, Gamma nails, PCCP, Medoff plate, LISS and dynamic hip screws for fixation in elderly trochanteric fractures: a systematic review and network meta-analysis of randomized controlled trials

被引：26

作者：

Arirachakaran A. ^{[1
]}

Amphansap T. ^{[1
]}

Thanindratarn P. ^{[2
]}

Piyapittayanun P. ^{[1
]}

Srisawat P. ^{[2
]}

Kongtharvonskul J. ^{[3
]}

机构：

[1] Orthopedics Department, Police General Hospital, Bangkok

[2] Department of Orthopedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok

[3] Sport and Orthopedic Center, Samitivej Hospital, Bangkok

来源：

European Journal of Orthopaedic Surgery & Traumatology | 2017年 / 27卷 / 7期

关键词：

DHS; Gamma nail; LISS; Medoff sliding plate; PCCP; PFN; Trochanteric fractures;

D O I：

10.1007/s00590-017-1964-2

中图分类号：

学科分类号：

摘要：

The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. The aim of this systematic review is to conduct a network meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between dynamic hip screws (DHS), Medoff sliding plating, percutaneous compression plating (PCCP), proximal femoral nails (PFN), Gamma nails and less invasive stabilization system fixation in femoral trochanteric fractures in the elderly. These clinical outcomes consist of total intra-operative time, intra-operative fluoroscopy time, intra-operative blood loss, blood component transfusion, length of hospital stay, postoperative general complications, wound complications, late complications and reoperation rates. This systematic review was conducted using PubMed and Scopus search engines for RCTs comparing clinical outcomes between treatments from inception to February 22, 2015. Thirty-six of 785 studies identified were eligible. Compared to the other implants, PCCP showed the lowest total operative time and units of blood transfusion with an unstandardized mean difference (UMD) of 29.27 min (95% CI 5.24, 53.50) and 0.89 units (95% CI 0.52, 1.25). The lowest incidence of general complications, wound complications and late complications of PCCP was 0.09 (95% CI 0.04, 0.18), 0.01 (95% CI 0.01, 0.04) and 0.05 (95% CI 0.02, 0.11), respectively, when compared to others. The lowest fluoroscopic time was with DHS with an UMD of 0.24 min (95% CI 0.16, 0.32), whereas the lowest blood loss and shortest hospital stay were with PFN with an UMD of 233.61 ml of blood loss (95% CI 153.17, 314.04) and 7.23 days of hospital stay (95% CI 7.15, 7.31) when compared to all other fixation methods. Reoperation rates of all implants had no statistically significant difference. The network meta-analysis suggested that fixation with PCCP significantly shortens operative time and decreases the units of blood transfusion required, while also lowering risks of general complications, wound complications and late complications when compared to fixation. Use of PFN showed the least intra-operative blood loss and shortest hospital stay. Multiple active treatment comparisons indicate that PCCP fixation in trochanteric fractures in the elderly is the treatment of choice in terms of intra-operative outcomes and postoperative complications. © 2017, Springer-Verlag France.

引用

页码：937 / 952

页数：15

共 30 条

[1]

Altman D.G., Bland J.M., Interaction revisited: the difference between two estimates, BMJ (Clin Res ed), 326, 7382, (2003)

[2]

Bojan A.J., Beimel C., Speitling A., Taglang G., Ekholm C., Jonsson A., 3066 consecutive Gamma nails. 12 years experience at a single centre, BMC Musculoskelet Disorders, 11, (2010)

[3]

Egger M., Davey Smith G., Schneider M., Minder C., Bias in meta-analysis detected by a simple, graphical test, BMJ (Clin Res ed), 315, 7109, pp. 629-634, (1997)

[4]

Ekstrom W., Karlsson-Thur C., Larsson S., Ragnarsson B., Alberts K.A., Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate, J Orthop Trauma, 21, 1, pp. 18-25, (2007)

[5]

Forte M.L., Virnig B.A., Eberly L.E., Swiontkowski M.F., Feldman R., Bhandari M., Kane R.L., Provider factors associated with intramedullary nail use for intertrochanteric hip fractures, J Bone Joint Surg Am, 92, 5, pp. 1105-1114, (2010)

[6]

Handoll H.H., Parker M.J., Conservative versus operative treatment for hip fractures in adults, Cochrane Datab Syst Rev, 3, (2008)

[7]

Huang X., Leung F., Liu M., Chen L., Xu Z., Xiang Z., Is helical blade superior to screw design in terms of cut-out rate for elderly trochanteric fractures? A meta-analysis of randomized controlled trials, Eur J Orthop Surg Traumatol, 24, 8, pp. 1461-1468, (2014)

[8]

Huang X., Leung F., Xiang Z., Tan P.Y., Yang J., Wei D.Q., Yu X., Proximal femoral nail versus dynamic hip screw fixation for trochanteric fractures: a meta-analysis of randomized controlled trials, Sci World J, 2013, (2013)

[9]

Hutton B., Salanti G., Caldwell D.M., Chaimani A., Schmid C.H., Cameron C., Ioannidis J.P., Straus S., Thorlund K., Jansen J.P., Mulrow C., Catala-Lopez F., Gotzsche P.C., Dickersin K., Boutron I., Altman D.G., Moher D., The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations, Ann Intern Med, 162, 11, pp. 777-784, (2015)

[10]

Kim W.Y., Han C.H., Park J.I., Kim J.Y., Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis, Int Orthop, 25, 6, pp. 360-362, (2001)

← 1 2 3 →