髋关节置换与内固定术治疗老年移位型股骨颈骨折术后再手术率和并发症的系统评价

Hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly patients： aMeta-analysis

目的系统评价髋关节置换与内固定术治疗老年移位型股骨颈骨折的术后再手术率、手术相关主要并发症及术后1年、2年病死率。方法计算机检索Pubmed／Medline、EMBASE、Cochrane网{5馆、中国知网、万方数据库、维普数据库，检索时间为建库至2013年5月，获取髋关节置换（关节嚣换组）与内固定术（内固定组）治疗老年移位型股骨颈骨折的随机对照试验（RCT）。比较两组患者术后2年内、2年以上再手术率、手术相关主要并发症及术后1年、2年病死率等。应用RevMan5．2．5统计学软件进行Meta分析。结果共纳入5篇RCTs，包括l288例患者。Meta分析结果硅示：内固定组患学术后2年内和2年以上再手术率（包括含内固定物取出手术和不含内同定物取m手术）均高于火节置换组，差异均有统计学意义（P〈0．05）。与关节置换组比较，内固定组患者手术相关主要并发症显著增加[OR=8．82，95％C1（6．45，12．07），P〈0．001]。内固定组和关节置换组术患者后1年、2年病死率比较差异均无统计学意义（P〉0．05）。结论对于老年移位型股骨颈骨折，内固定术后再手术率、手术相关主要并发症发生率均明显高于髋关节置换，但术后1年、2年病死率二者比较无明显差异，推荐采用髋关节氍换术治疗老年移位型股骨颈骨折。

Objective To compare hip arthroplasty versus internal fixation for treatment uf displaced femoral neck fractures in the elderly patients in terms of reoperation, surgery-related complieations and post- operative 1-2-year mortality. Methods All the randomized controlled trials （RCTs） up to May 2013 on hip arlhroplasty versus internal fixation for displaced femoral neck fractures in the elderly were electronically searched for in Pubmed/Medline, EMBASE, Cochrane CENTRAL, CNKI, WanFang and VIP databases. The 2 treatments were compared in lerms of reoperation, surgery-related complications and postoperative 1-2-year mortality. The Meta analysis was pedbrmed with RevMan 5.2.5 software. Results Five eligible RCTs involving 1 288 cases were included for this review. The rate of reoperation （including implant remuval and other operations）, either within 2 years or over 2 years, in the internal fixation group was significantly higher than that in the arthroplasty group （ P 〈 0.05）. The surgery-related complications in the internal fixation group was significantly higher than that in the hip arthroplasty group [ OR =8.82, 95% CI （6.45, 12.07）, P 〈 0. 001 ]. No significant difference was found in the postoperative 1-2-year mortality between the 2 groups （ P 〉 0.05） . Conclusion In the treatment of displaced femoral neck fractures in the elderly, cnmpared with internal fixation, arthroplasty should be recommended as the first choice, because it can significantly reduce surgery-related complications and reoperations though it cannot decrease the postoperative 1-2-year mortality.