摘要
目的应用Cochrane系统评价的方法,评价半髋关节置换与全髋关节置换治疗股骨颈骨折的效果差异,以期为临床选择髋关节置换的方式提供依据。方法计算机检索MEDLINE(1975年至2007年5月)、Cochrane图书馆(2007年第2期)、EMBASE(1980至2007年)、ScienceDirect数据库(1975年至2007年5月)、LWW全文数据库(1975年至2007年5月)和中国生物医学文献数据库(CBM,1978至2007年)、中文生物医学期刊目次数据库(CMCC,1994至2007年)、中国医学学术会议论文数据库(CMAC,1994至2007年)、中国期刊全文数据库(CJFD,1994至2007年)、中文科技期刊数据库(1989至2007年)。手工检索《中华创伤杂志》、《中华骨科杂志》、《中华创伤骨科杂志》、《中国矫形外科杂志》、《创伤外科杂志》和《实用骨科杂志》,均从创刊检索至2007年1月,收集半髋关节置换与全髋关节置换治疗股骨颈骨折的随机对照实验。纳入研究的方法学质量按Cohrane Reviewer's Handbook 4.2.6随机对照试验的质量标准进行评价。采用Cochrane协作网提供的Review Manager 5软件进行Meta分析。结果纳入随机对照实验6篇,共788例患者。Meta分析显示,半髋关节置换与全髋关节置换相比,后者治疗后翻修率低(RR合并=2.27,95%CI=1.36~3.81,P=0.002),术后疼痛发生率低(RR合并=11.83,95%CI=5.11~27.39,P〈0.01),但术后假体脱位发生率高(RR合并=0.59,95%CI=0.38~0.94,P=0.020)。同时在不同的评分标准下,全髋置换术后髋关节功能都优于半髋置换。在术后死亡率、切口感染率方面,两者差异无统计学意义(P〈0.05)。结论半髋关节置换与全髋关节置相比,全髋置换能降低翻修率、减轻术后疼痛、提高术后髋关节功能,半髋置换能够减少假体脱付、手术时间、术中出血。但是在术后死亡率、切口感染率方面,两者差异无统计学意义(P〉0.05)。
Objective To evaluate the differences between 2 therapeutic methods for femoral neck fractures using the method of Cochrane systematic review. Methods We searched on-line MEDLINE (1975-2007.5), Cochrane library (Issue 2, 2007), EMBASE (1980-2007), ScienceDirect (1975-2007.5), LWW (1975-2007.5), CBM (1978-2007), CMCC (1994-2007), CMAC (1994-2007), CJFD (1994-2007), and searched by hand the 6 relevant Chinese orthopedic journals. Randomized controlled trials (RCT) of hemiarthroplasty versus total hip arthroplasty for displaced femoral neck fractures were included. The quality of trials was critically assessed. RevMan 5 software was used for data analysis. Results Six RCTs involving 788 cases were included. The combined results of meta analysis showed that total hip arthroplasty for displaced femoral neck fractures decreased the rates of revision (RR=2.27, 95% CI=1.36-3.81, P=0.002) and pain (RR=11.83, 95% CI=5. 11-27.39, P〈0.000), but increased the rate of dislocations (RR=0.59,95% CI=0.38-0.94, P=0.02). Assessments by different hip function scales revealed that hip functions after total hip arthroplasty were better than those after hemiarhtroplasty. But there were no differences between hemiarthroplasty and total hip arthroplasty in mortality rate and infection rate. Conclusions Compared with hemiarthroplasty group, total hip arthroplasty can decrease revision rate, pain and increase hip function. Hemiarthroplasty can decrease dislocation rate, surgical time and blood loss. "There may be no significant difference in mortality and infection rate. More and larger randomized controlled trials, however, are needed to increase the level of evidence.
出处
《中华创伤骨科杂志》
CAS
CSCD
2008年第3期223-228,共6页
Chinese Journal of Orthopaedic Trauma
关键词
股骨颈骨折
关节成形术
置换
髋
系统分析
Femoral neck fracture
Arthroplsty, replacement, hip
Systems analysis