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Abstract：
OBJECTIVE: The aim of this systematic review was to compare extramedullary fixation and intramedullary fixation for AO type 31-A2 trochanteric fractures in the elderly, with regard to functional outcomes, complications, surgical outcomes, and costs.
METHODS: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI).
RESULTS: Fourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91-7.26, p = 0.04), Parker mobility score (MD - 0.67 95% CI - 1.2 to - 0.17, p = 0.009), lower extremity measure (MD - 4.07 95% CI - 7.4 to - 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92-1.35, p < 0.001), superficial infection (RR 2.06, 95% CI 1.18-3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03-13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16-4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81-3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56-3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63-20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51-218, p = 0.002), and tip-apex distance > 25 mm (RR 1.73, 95% CI 1.10-2.74, p = 0.02). No comparable cost/costs-effectiveness data were available.
CONCLUSIONS: Current literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.
METHODS: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI).
RESULTS: Fourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91-7.26, p = 0.04), Parker mobility score (MD - 0.67 95% CI - 1.2 to - 0.17, p = 0.009), lower extremity measure (MD - 4.07 95% CI - 7.4 to - 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92-1.35, p < 0.001), superficial infection (RR 2.06, 95% CI 1.18-3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03-13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16-4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81-3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56-3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63-20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51-218, p = 0.002), and tip-apex distance > 25 mm (RR 1.73, 95% CI 1.10-2.74, p = 0.02). No comparable cost/costs-effectiveness data were available.
CONCLUSIONS: Current literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.
摘要：
目的：本系统评价的目的是比较老年AO31-A2型股骨粗隆间骨折的髓外固定和髓内固定，关于功能结果，并发症,手术结果,和成本。
方法：Embase，Medline,WebofScience,Cochrane中央控制试验登记册,和GoogleScholar进行了随机对照试验（RCT）和观察性研究。使用随机效应模型对研究中的效应估计进行汇总。结果以加权风险比（RR）或加权平均差（MD）表示，并带有相应的95％置信区间（95％CI）。
结果：纳入14项RCTs（2039例患者）和13项观察性研究（22,123例患者）。Harris髋关节评分的统计学结果优于髓内固定（MD4.09，95％CI0.91-7.26，p=0.04），Parker行动评分（MD-0.6795%CI-1.2至-0.17，p=0.009），下肢测量（MD-4.0795%CI-7.4至-0.8，p=0.02），达到完全负重的时间(MD1.14周CI0.92-1.35，p<0.001)，浅表感染（RR2.06，95%CI1.18-3.58，p=0.01），不愈合(RR3.67，95%CI1.03-13.10，p=0.05)，固定失败(RR2.26，95%CI1.16-4.44，p=0.02)，腿部缩短(MD2.23mm,95%CI0.81-3.65，p=0.002），放射性骨愈合时间（MD2.19个月，95%CI0.56-3.83，p=0.009），手术持续时间(MD11.63分钟，95%CI2.63-20.62，p=0.01），手术失血（MD134.5mL，95%CI51-218，p=0.002），尖端-顶点距离>25mm（RR1.73，95%CI1.10-2.74，p=0.02）。没有可比的成本/成本效益数据。
结论：目前的文献表明，几种功能结果，并发症,与AO/OTA31-A2骨折的髓外固定相比，手术结果在统计学上有利于髓内固定。然而,由于发现的一些差异似乎与临床无关，并且对于许多结果数据仍然稀疏或异质，IM内固定治疗AO31-A2型骨折的完全优越性仍有待详细的成本-效果分析证实.
方法：Embase，Medline,WebofScience,Cochrane中央控制试验登记册,和GoogleScholar进行了随机对照试验（RCT）和观察性研究。使用随机效应模型对研究中的效应估计进行汇总。结果以加权风险比（RR）或加权平均差（MD）表示，并带有相应的95％置信区间（95％CI）。
结果：纳入14项RCTs（2039例患者）和13项观察性研究（22,123例患者）。Harris髋关节评分的统计学结果优于髓内固定（MD4.09，95％CI0.91-7.26，p=0.04），Parker行动评分（MD-0.6795%CI-1.2至-0.17，p=0.009），下肢测量（MD-4.0795%CI-7.4至-0.8，p=0.02），达到完全负重的时间(MD1.14周CI0.92-1.35，p<0.001)，浅表感染（RR2.06，95%CI1.18-3.58，p=0.01），不愈合(RR3.67，95%CI1.03-13.10，p=0.05)，固定失败(RR2.26，95%CI1.16-4.44，p=0.02)，腿部缩短(MD2.23mm,95%CI0.81-3.65，p=0.002），放射性骨愈合时间（MD2.19个月，95%CI0.56-3.83，p=0.009），手术持续时间(MD11.63分钟，95%CI2.63-20.62，p=0.01），手术失血（MD134.5mL，95%CI51-218，p=0.002），尖端-顶点距离>25mm（RR1.73，95%CI1.10-2.74，p=0.02）。没有可比的成本/成本效益数据。
结论：目前的文献表明，几种功能结果，并发症,与AO/OTA31-A2骨折的髓外固定相比，手术结果在统计学上有利于髓内固定。然而,由于发现的一些差异似乎与临床无关，并且对于许多结果数据仍然稀疏或异质，IM内固定治疗AO31-A2型骨折的完全优越性仍有待详细的成本-效果分析证实.
