人工髋关节置换术与内固定术治疗老年不稳定股骨粗隆间骨折的Meta分析

Hip arthroplasty versus internal fixation for unstable intertrochanteric fractures in the elderly:a meta-analysis

目的系统评价人工髋关节置换术与内固定术治疗老年不稳定股骨粗隆间骨折的疗效和安全性。方法计算机检索MEDLINE、EMBASE、CENTRAL、CNKI、万方、维普、Clinical trials、NRR Archive、CCT、ISI Proceedings、CACP、SIGLE等数据库,手工检索近10年来相关骨科期刊,获取所有人工髋关节置换术与内固定术治疗老年不稳定股骨粗隆间骨折的随机或半随机对照试验。由2名研究员分别独立使用Cochrane 5.1.0风险偏倚评估工具对文献的方法学偏倚进行评价,提取文献数据并录入Revman 5.2软件行Meta分析。结果共4篇文献、269例纳入Meta分析,其中关节置换组131例,内固定组138例。Meta分析结果显示,关节置换组输血量(Z=3.02,P=0.003<0.05)、需要接受输血例数(Z=2.17,P=0.03<0.05)大于内固定组;2组在手术时间、术中出血量、术后下地负重时间、术后并发症、术后再次手术例数、病死率、住院时间、术后Harris评分方面差异无统计学意义。结论目前尚无充分证据表明老年不稳定股骨粗隆间骨折治疗中人工髋关节置换术优于内固定术,临床医师应根据患者的具体情况选择个体化的治疗方法。

Objective To provide an evidence for management of unstable intertrochanteric fractures in the elderly by performing a systematic review（meta-analysis） on hip arthroplasty versus internal fixation.Methods Database MEDLINE,EMBASE,CENTRAL,CNKI,Wanfang Data,CQVIP,Clinical Trials,NRR Archive,CCT,ISI proceedings,CACP and SIGLE were searched for all randomized or quasi-randomized controlled trials on hip arthroplasty versus internal fixation for unstable intertrochanteric fractures in the elderly.Some relevant orthopaedic journals were also searched.Only English or Chinese literatures were included.Two investigators individually assessed the risk bias of each trial based on the Cochrane 5.1.0.Each outcome data was subsequently collected and inputted into Revman 5.2 for further meta-analysis.Results Four trials with a total number of 269 patients were identified,among which 131 patients received hip arthroplasty while 138 patients received internal fixation surgery.Meta-analysis demonstrated that the arthroplasty group required more blood to be transfused peri-operatively（Z =3.02,P =0.003〈0.05） and the number of patients who needed blood transfusion was also higher（Z =2.17,P =0.03〈0.05）.The 2 groups showed no significant differences on the operative time,operative blood loss,time to weight bearing,complication rate,reoperation rate,mortality,hospital stay and postoperative Harris hip score.Conclusion There are insufficient evidences to determine whether arthroplasty has any advantages over internal fixation for unstable intertrochanteic fractures in the elderly.More randomized controlled trials of larger sample sizes are needed.