摘要
目的对国内外有关髋关节置换与内固定治疗老年移位型股骨颈骨折研究的文献进行分析,评价其临床疗效及安全性。方法计算机检索Cochrane图书馆(2014年1期)、MEDLINE、EMbase、Pud Med、CNKI等数据库。检索1969年1月至2013年12月有关比较髋关节置换与内固定治疗老年人(>60岁)移位型股骨颈骨折的随机对照试验(randomized controlled trial,RCT),筛选出符合纳入标准的文献,并对其进行严格的质量评价。利用Cochrane协作网提供的Rev Man5.0软件对纳入研究结果进行Meta分析,并对数据进行异质性检验。结果共检索到相关文献124篇,最终纳入24个RCT,共4859例,髋关节置换组2619例,内固定组2240例。结果显示,髋关节置换组的再手术率显著低于内固定组[OR=0.13,95%CI(0.09,0.18),P<0.00001],主要并发症发生率显著小于内固定组[OR=0.15,95%CI(0.10,0.22),P<0.00001],差异有统计学意义。而在随访2年、10年及以上的病死率比较中,差异均无统计学意义。结论髋关节置换治疗老年人移位型股骨颈骨折可明显降低术后再手术率及主要并发症发生率,但不能降低其病死率。因此,老年移位型股骨颈骨折最佳的选择还是髋关节置换。
Objective To analyze the domestic and foreign literatures on hip arthroplasty and internal fixation for displaced femoral neck fractures in the elderly and to evaluate the clinical outcomes and safety. Methods Cochrane central register of controlled trials （ Issue 1, 2014 ） and MEDLINE, EMbase, PubMED and China National Knowledge Infrastructure （ CNKI ） from January 1969 to December 2013 were searched by the computer. Only randomized controlled trials （ RCT ） in which hip arthroplasty and internal ifxation were compared in the treatment of femoral neck fractures in the elderly （ 〉60 years old ） were included. The literatures meeting the inclusion criteria were screened, and then were strictly evaluated. A meta-analysis of the research results was performed by the RevMan5.0 software from the Cochrane collaboration, and additionally the heterogeneity of data was checked.Results There were 124 potentially relevant papers, and 24 RCT were included at last. A total of 4859 cases were included, with 2619 cases in the hip arthroplasty group and 2240 cases in the internal ifxation group. The meta-analysis results showed both the reoperation rate and the complication rate were obviously lower in the hip arthroplasty group than that in the internal ifxation group [OR=0.13, 95%CI （ 0.09, 0.18 ）,P〈0.00001 ] [OR=0.15, 95%CI （ 0.10, 0.22 ）,P〈0.00001 ], and the differences between them were statistically signiifcant. No statistically signiifcant differences were noticed in the case fatality rate in the follow-up of 2 years, 10 years and more than 10 years.Conclusions The postoperative rate of reoperation and the complication rate can be obviously reduced in the elderly patients with displaced femoral neck fractures undergoing hip arthroplasty, but the case fatality rate cannot be reduced. Therefore, hip arthroplasty is the best choice in the treatment of displaced femoral neck fractures in the elderly.
出处
《中国骨与关节杂志》
CAS
2015年第4期264-271,共8页
Chinese Journal of Bone and Joint
关键词
股骨颈骨折
骨折固定术
内
关节成形术
置换
髋
META
分析
Femoral neck fractures
Fracture fixation,internal
Arthroplasty,replacement,hip
Meta-analysis
