股骨颈骨折患者早期手术对比后期手术安全性的Meta分析

Meta-analysis of studies on mortality of early surgery vs delayed surgery for patients with femoral neck fractures

目的:关于股骨颈骨折早期手术是否可以降低患者病死率的研究结果并不完全一致,本研究探讨股骨颈骨折患者早期对比后期行手术治疗对患者病死率的影响。方法:通过计算机检索Medline、EMBASE、CENTRAL(theCochranecentralregisterofcontrolledtrials)、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)等,收集股骨颈骨折患者早期手术对比后期手术治疗效果的研究文献。应用统计软件Stata11.0进行数据分析,计算其合并相对危险度(relativerisk,RR)和95%置信区间(confidenceinterval,CI)。采用Egger法对发表偏倚进行量化检测。结果:纳入分析的文章有6篇,均为观察性的队列研究,共纳入8430例患者。合并分析结果表明:早期行手术治疗患者的死亡风险是后期行手术治疗的64%(RR=0.64,95%CI:0.55～0.73,P=0.000);按死亡时间为30d以内的早期术后死亡和6个月及以上的后期死亡分为2个亚组。早期病死率,早期手术与后期手术无差别(RR=0.93,95%CI:0.69～1.18,P=0.076);后期病死率,早期行手术治疗患者的病死率是后期手术治疗的59%(RR=0.59,95%CI:0.49～0.69,P=0.000)。结论:股骨颈骨折患者早期行手术治疗可以显著降低患者的病死率。

Objective：Current guidelines indicate that surgery for femoral neck fracture should be performed within 24 hours.But the effect of early surgery on mortality was not consistent with each other.This study is to explore the effect of early surgery on the risk of death among elderly patients with femoral neck fracture.Methods：By searching Medline,PubMed,CENTRAL（the Cochrane central register of controlledtrials）,CBM,CNKI and VIP et al,published documents about studies of early surgery VS delayed surgery on mortality for femoral neck fractures were collected.The data were analysised by using statistic software Stata 11.0.Random or fixed effect models were applied to conduct Meta analysis on the study results,the combined relative risk （RR） and the 95% confidence interval（CI） were calculated as well.Results：Six cohort studies and 8 430 patients were included in the combined analysis,which indicated that 64% death risk was observed in the early surgery group compared to the delayed surgery group（RR=0.64,95%CI：0.55～0.73,P=0.000）.The death was divided into two subgroups：one was early death with 30 days and the other was late death after 6 months.For the early death,there was no statistic significance between early surgery and delayed surgery（RR=0.93,95%CI：0.69～1.18,P=0.076）.And for the late death,only 59% death risk was observed in the early surgery group（RR=0.59,95%CI：0.49～0.69,P=0.000）compared to the delayed surgery group.Conclusion：Early surgery was associated with a lower risk of death for femoral neck fracture patients.