Table1_Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: A systematic review and meta-analysis.docx

ObjectiveTitanium elastic nails (TENs) and locking plates (LPs) are currently the main internal fixation for treating pediatric subtrochanteric femur fractures, and the optimal choice of internal fixation is controversial. This study aimed to systematically evaluate the effectiveness and safety of TENs and LPs in treating subtrochanteric fractures in children to provide a theoretical basis and reference for clinical treatment.
MethodsThe literature related to TENs and LPs for treating subtrochanteric fractures in children was searched using the CNKI, PubMed, Cochrane, Embase, and Web of Science, and the search time frame was from the establishment of the database to October 2022. Two evaluators screened the literature according to the inclusion and exclusion criteria and extracted relevant data. Meta-analysis was performed using Stata14.0 software.
ResultsA total of 9 studies with 407 patients with subtrochanteric femur fractures were included in the final screening, including 210 cases with TENs and 197 cases with LPs. Meta-analysis results showed that compared with the locking plate, TEN had a shorter operative time [WMD = −1.3, 95%CI(−1.94,-0.66), p < 0.01], less intraoperative bleeding [WMD = −84.45, 95%CI(−111.09, −57.82), p < 0.01], shorter fracture healing time [WMD = −1.3, 95%CI(−1.94,−0.66), P < 0.01], shorter hospital stays [WMD = −2.80, 95% CI(−4.63,−0.98), p < 0.01], and earlier full weight bearing [SMD = −0.48, 95% CI(−0.91,−0.04), p < 0.05] but more intraoperative fluoroscopy [WMD = 28.23, 95% CI(15.22,41.25), p < 0.05]. The overall complication rate was high [OR = 3.52, 95% CI(1.96,6.34), p < 0.05], and the postoperative period was prone to angulation, rotation, and inversion deformity [OR = 3.68, 95% CI(1.40, 9.68), p < 0.05]. No significant difference in the incidence of lower limb inequality between the two types of internal fixation [OR = 0.83, 95% CI(0.38, 1.85), p > 0.05] and no significant difference in the Harris score of the hip at the last follow-up between the two types of internal fixation [WMD = −0.67, 95% CI(−2.01,0.67), p > 0.05] were found.
ConclusionIn comparison to LPs, TENs have a shorter operation time, less intraoperative bleeding, and a shorter fracture healing time, and the child can be fully weight-bearing earlier. Locking plates can reduce the operator's x-ray exposure, and the incidence rate of postoperative angulation, rotation, and inversion deformity is low. Therefore, TENs and LPs are the best internal fixation methods for treating subtrochanteric fractures in children.

研究背景与目的：当前，钛弹性钉（Titanium elastic nails, TENs）与锁定钢板（locking plates, LPs）是治疗儿童股骨转子下骨折的主流内固定方式，但二者的临床最优选择仍存在争议。本研究旨在系统评价TENs与LPs治疗儿童股骨转子下骨折的有效性与安全性，为临床诊疗提供理论依据与参考。

研究方法：本研究通过中国知网（CNKI）、PubMed、Cochrane图书馆、Embase及Web of Science数据库，检索儿童股骨转子下骨折采用TENs与LPs治疗的相关文献，检索时限为各数据库建库起至2022年10月。由2名独立评价者按照预设的纳入与排除标准筛选文献并提取相关数据，采用Stata14.0软件完成Meta分析。

研究结果：最终共纳入9项临床研究，合计407例股骨转子下骨折患儿，其中TENs组210例，LPs组197例。Meta分析结果显示：与LPs组相比，TENs组手术时间更短[加权均数差（WMD）=-1.3，95%置信区间（CI）(-1.94, -0.66)，p<0.01]、术中出血量更少[WMD=-84.45，95%CI(-111.09, -57.82)，p<0.01]、骨折愈合时间更短[WMD=-1.3，95%CI(-1.94, -0.66)，p<0.01]、住院时长更短[WMD=-2.80，95%CI(-4.63, -0.98)，p<0.01]，且可更早实现完全负重[标准化均数差（SMD）=-0.48，95%CI(-0.91, -0.04)，p<0.05]；但TENs组术中透视次数更多[WMD=28.23，95%CI(15.22, 41.25)，p<0.05]。两组总体并发症发生率方面，TENs组显著更高[比值比（OR）=3.52，95%CI(1.96, 6.34)，p<0.05]，且TENs组术后更易出现成角畸形、旋转畸形及内翻畸形[OR=3.68，95%CI(1.40, 9.68)，p<0.05]。此外，两种内固定方式在下肢不等长发生率[OR=0.83，95%CI(0.38, 1.85)，p>0.05]及末次随访时髋关节Harris评分[WMD=-0.67，95%CI(-2.01, 0.67)，p>0.05]上均无显著统计学差异。

研究结论：与LPs相比，TENs具有手术时间短、术中出血量少、骨折愈合时间快的优势，且患儿可更早实现完全负重；而LPs可降低术者的X射线暴露量，术后成角、旋转及内翻畸形的发生率更低。综上，TENs与LPs均为治疗儿童股骨转子下骨折的优质内固定方式。