全髋关节置换术与切开复位内固定术治疗老年股骨颈骨折的系统评价

Total hip replacement versus internal fixation for treatment of femoral neck fractures in elderly patients： a systematic evaluation

目的对全髋关节置换与切开复位内固定术治疗老年股骨颈骨折的疗效进行系统评价。方法计算机检索MEDLINE（1966年5月至2006年5月）、EMBASE（1966年5月至2006年5月）、Cochrane图书馆（2006年第1期）、Cochrane协作网肌骨创伤组试验数据库（2006年5月）和中国生物医学文献数据库（1979年5月至2006年5月），手工检索近5年国内已发表的有关骨科论文和会议资料，收集所有相关随机对照试验及半随机对照试验，并评价纳入研究的方法学质量。统计软件用Cochrane协作网提供的RevMan4．2．8。结果共纳入8个随机对照试验。Meta分析显示，与切开复位内固定术相比，全髋关节置换术能降低股骨颈骨折的再手术率（RR=0．15，95％C10．09-0．26，P=0．58）和术后髋关节疼痛率（RR=0．70，95％C10．59-0．85，P=0．10）。结论与切开复位内固定术相比，全髋关节置换术能降低股骨颈骨折的再手术率和术后髋关节疼痛发生率；全髋关节置换术与切开复位内固定术的术后病死率比较，差异无统计学意义。但两种手术方式与肺部并发症、骨折愈合时间、感染、手术时间及失血量等指标的关系，以及经济学评价有待于进一步研究。

Objective To evaluate the effects of total hip replacement versus internal fixation for treatment of femoral neck fractures in elderly patients on the case-fatality rate after operation 12-24 months, the rates of reoperation and rates of pain of hip joint after operation. Methods Randomized controlled trials （RCT） and clinical controlled trials （CCT） were identified from MEDLINE （1966.5-2006.5）, EMBASE （1966.5-2006.5）, Cochrane Library （Issue 1, 2006）, Cochrane Musculoskeletal Injuries Group Database （2006.5）, and CBM disc （1979.5-2006.5）. The relative orthopaedic papers pulished in Chinese journals and meeting materials in recent 5 years were collected by hand. RCTs and CCTs were included. Data were extracted by two reviewers with designed extraction form. The quality of trials was critically assessed. RevMan 4.2.8 software was used for data analysis. Results Eight RCTs were included. The combined results of meta-analysis showed that compared with internal fixation, total hip replacement could reduce the rate of reoperation（RR=0.15,95%Cl 0.09-0.26, P=-0.58） and the rate of hip pain after operation （RR=0.70,95%C1 0.59-0.85,P=0.10）. Conclusion Compared with internal fixation, total hip replacement can reduce the rate of reopreation and the rate of hip pain after operation. There were no statistical difference on the casefatality rates of after operation in 12-24 months. However, the relation between the two operations and pulmonary complications, the time of union, infection, operative time, blood loss and evaluation of economy needs further study.