髋关节置换和内固定修复老年股骨颈骨折再手术及并发症的系统分析

Hip arthroplasty and internal fixation for the repair of femoral neck fracture in the elderly patients: a meta-analysis of reoperation and complications

背景:目前对于老年股骨颈骨折,髋关节置换和内固定治疗均是有效的治疗方法,但选择哪种方法能减少术后并发症的发生存在争议。目的:系统评价老年股骨颈骨折髋关节置换和内固定治疗后再手术、手术相关并发症和术后1,2年死亡率。方法:计算机检索2013年5月前PubMed/Medline、EMBASE、Cochrane CENTRAL数据库。应用Cochrane协作网提供的Rev Man 5.2软件系统评价,对老年股骨颈骨折内固定和髋关节置换的随机对照试验进行Meta分析,观察指标包括治疗后再手术、手术相关主要并发症及死亡率。结果与结论:6个随机对照试验(9篇文献)纳入研究,共1 496个病例。Meta分析结果显示,内固定组术后2年内和2年以上再手术率均高于髋关节置换组(P<0.000 01)。与髋关节置换相比,内固定显著增加了手术相关主要并发症[OR=8.79,95%CI(6.50-11.88),P<0.000 01]。股骨颈骨折内固定组和置换组术后1年内、2年内死亡率比较差异无显著性意义[OR=0.85,95%CI(0.66-1.11),P=0.23;OR=0.88,95%CI(0.70-1.10),P=0.27]。提示老年股骨颈骨折内固定治疗远期再手术率、手术相关主要并发症发生率均明显高于髋关节置换,两种治疗方法术后1年、2年内死亡率无明显差异,临床推荐采用髋关节置换修复老年股骨颈骨折。

BACKGROUND：Hip arthroplasty and internal fixation are presently effective therapeutic methods in treatment of femoral neck fracture in the elderly. However, which method can reduce the incidence of postoperative complications remains controversial. OBJECTIVE：To systematical y review the reoperation, postoperative complications and 1-year and 2-year mortality after hip arthroplasty and internal fixation in the elderly with femoral neck fracture. METHODS：Pubmed/Medline, EMBASE, and Cochrane CENTRAL databases were retrieved by computer for articles published before May 2013. Systematic review on randomized control ed trials of hip arthroplasty versus internal fixation for femoral neck fractures in the elderly was conducted using the Cochrane Col aboration’s RevMan 5.2 software. Outcome measures included reoperation, main complications related to the surgery and mortality. RESULTS AND CONCLUSION：Six published randomized control ed trials of nine literatures containing 1 496 cases were involved in this review. Meta-analysis results indicated that reoperation rate was greater in the internal fixation group within and more than 2 years after the surgery compared with the hip arthroplasty group （P〈0.000 01）. Compared with hip arthroplasty group, internal fixation significantly increased the main complications related to the surgery [OR=8.79, 95%CI（6.50-11.88）, P〈0.000 01]. No significant difference in 1-year and 2-year mortality after surgery was detected between the internal fixation and hip arthroplasty groups [OR=0.85, 95%CI（0.66-1.11）, P=0.23;OR=0.88, 95%CI（0.70-1.10）, P=0.27]. These data suggested that the long-term reoperation rate and incidence of main complications were obviously higher in internal fixation compared＆amp;nbsp;with hip arthroplasty for femoral neck fracture in the elderly, and no significant difference in 1-year and 2-year mortality after the surgery was detectable between the two methods. Clinical recommended hip arthroplasty in the repair of femoral neck fracture in the elderly.