人工髋关节置换治疗老年股骨颈骨折的Meta分析

Meta-analysis of literatures on hip arthroplasty treating femoral neck fracture in the elderly

目的对国外有关人工髋关节置换治疗老年股骨颈骨折的研究文献进行分析，评价老年股骨颈骨折的治疗效能。方法计算机检索PubMED和Ovid等数据库，检索时间从1991年至2007年有关人工关节置换治疗老年股骨颈骨折的文献资料。比较人工关节置换手术的病死率、脱位、关节翻修率、关节功能。对数据进行异质性检验，用Meta分析方法对数据进行处理，估计其综合比值比（oddsratio，OR值）和95％置信区间（confidence interval，95％CI）。结果共纳入10篇相关的、以半髋和全髋关节置换对照治疗老年股骨颈骨折的文献。研究结果提示，两者的病死率之间差异无统计学意义；脱位率和翻修率之间Q值分别为4．03和2．78（P〉0．1），不存在异质性，总体效应的P〈0．01，全髋关节的脱位率高，但是翻修率低于半髋关节置换；关节功能Har-ris评分的Q值分别为23．94（P〈0．1），存在异质性，总体效应的P〈0．01，相对危险度（RR）为0．79，OR为0．35，95％CI为0．23～0．53，全髋置换术后髋关节功能明显优于半髋关节置换术后的患者。结论全髋关节置换术优于半髋关节置换术，在选择关节置换治疗老年股骨颈骨折时候，尽量全髋置换。对于不能耐受全髋关节置换手术和预期寿命低于5年的患者，则采用半髋关节置换。

Objective To analyze the literatures on arthroplasty treating femoral neck fracture in the elderly so as to evaluate the value of arthroplasty in treating femoral neck fracture in the elderly, Methods The literatures published from 1991 to 2007 on arthroplasty treating femoral neck fracture in the elderly were retrieved via PubMED and Ovid database to compare the mortality, dislocation, revision and Harris score after operation, The heterogeneity was tested and the data dealt by meta-analysis, Then, we calculated the OR value and 95% confidence interval. Results The study included 10 related papers involving hemi-arthroplasty （HA） and total hip arthroplasty （THA） treating femoral neck fracture in the elderly. There was no statistical difference between HA and THA in aspect of mortality, No heterogeneity existed in dislocation and revision, with the Q value of 4, 03 and 2, 78 respectively （P 〉 0, 1 ）, THA had a high dislocation rate but lower incidence of revision, in comparison with HA. The heterogeneity of Harris score was confirmed with the Q value of 23.94 （ P 〈 0. 1 ）, with relative risk （RR） of 0, 79, OR of 0, 35 and 95% CI of 0. 23-0.53, Conclusions As for hip function recovery, THA is better than hemi-arthroplasty and THA should be the first choice for femoral neck fracture. However, for patients who can not tolerate operation or have anticipated life span less than 5 years, hemi-arthroplasty should be chosen.