全髋关节置换与双极人工股骨头置换治疗老年股骨颈骨折的Meta分析

Total hip replacement and bipolar hemiarthroplasty for femoral neck fracture in the elderly:A Meta analysis

背景:采用双极人工股骨头或全髋关节置换,可以较快速地重建髋关节功能,是目前治疗老年股骨颈骨折比较理想而可靠的方法。目的:通过Meta分析对全髋关节置换与双极人工股骨头置换治疗老年股骨颈骨折的疗效进行系统评价。方法:计算机检索下列数据库:Medline(1990/2011-03,Ovid检索平台),Embase(1984/2011-03),CochraneCentralRegisterofControlledTrial(Issue2,2011),CurrentControlledTrials,中国生物医学文献数据库(1986/2011-03)。手工检索相关杂志。纳入全髋关节置换与双极人工股骨头置换治疗老年股骨颈骨折的随机对照试验,按照CochraneHandbook5.1进行严格的质量评估,采用RevMan5.1.1软件进行Meta分析。结果与结论:共纳入6个随机对照试验,共899例患者。Meta分析结果显示,与双极人工股骨头置换比较,全髋关节置换后Harris评分显著提高,但在需二次手术人数、术后发生脱位人数、1年死亡率、并发症等方面两者差异无显著意义。全髋关节置换在手术时间、术中出血量、术后卧床时间、置换后住院时间、住院总费用等方面均较双极人工股骨头置换显著增多。

BACKGROUND：Bipolar hemiarthroplasty or total hip replacement can quickly recover hip function,which is the ideal and reliable treatment of femoral neck fracture in the elderly.OBJECTIVE：To systemically assess the effects of bipolar hemiarthroplasty and total hip replacement on femoral neck fracture in the elderly through a Meta analysis.METHODS：Medline（1990/2011-03）,Embase（1984/2011-03）,Cochrane Central Register of Controlled Trial（Issue 2,2011）,Current Controlled Trials,and CMB（1986/2011-03） were searched by computer for randomized controlled trials of bipolar hemiarthroplasty and total hip replacement for femoral neck fracture in the elderly.And the retrieved studies were strictly evaluated in accordance with the Cochrane Handbook 5 and underwent the Meta analysis using RevMan 5.1.1 software.RESULTS AND CONCLUSION：Totally 6 randomized controlled trials with 899 patients were included.The results of Meta analysis showed that the Harris score after total hip replacement was higher than that after bipolar hemiarthroplasty.However,there were no significant differences in the number of patients requiring reoperation,the number of postoperative dislocation,1-year mortality,and complications.As compared with patients with semi-hip replacement,the operation time,intraoperative bleeding volume,postoperative bed time,postoperative hospital staying,hospital cost were obviously increased in patients with total hip replacement.