人工关节置换与内固定修复老年股骨转子间骨折的Meta分析

A meta-analysis of arthroplasty versus internal fixation in treatment of intertrochanteric fracture in the elderly

背景:股骨转子间骨折是老年人常见的骨折之一,其手术治疗方式包括人工全髋和人工股骨头置换和股骨近端防旋髓内钉和动力髋螺钉内固定,但是目前并没有明确的研究证据来评价两者疗效的差异。目的:比较人工关节置换与内固定修复老年股骨转子间骨折的效果差异。方法:分析检索从1990至2015年期间关于采用人工关节置换(人工全髋置换和人工股骨头置换)与内固定(股骨近端防旋髓内钉和动力髋螺钉)修复股骨转子间骨折随机对照研究的文献,采用Meta分析方法对2种关节置换和2种内固定修复股骨转子间骨折患者的手术时间、手术出血量、修复后1年髋关节功能Harris评分、修复后1年并发症的差异进行比较。结果与结论:(1)共纳入21篇文献;(2)出血量比较,全髋及人工股骨头置换组术中出血量及患者术后1年髋关节功能Harris评分方面高于内固定组;(3)手术时间比较,全髋及人工股骨头置换组手术时间与内固定组接近;(4)修复后并发症比较,人工股骨头置换组并发症发生率低于内固定组,而人工髋关节置换与内固定组术后1年并发症发生率接近;(5)结果说明,人工股骨头置换修复老年人股骨转子间骨折的效果优于内固定,但仍需前瞻性大样本、长期的随机对照试验来验证。

BACKGROUND： Intertrochanteric fracture is one of the most common fractures in older adults. The surgical treatment methods include artificial joint replacement（total hip and femoral head replacement） and internal fixation（proximal femoral nail anti-rotation and dynamic hip screw）, but there is no clear evidence to evaluate the effect of them.OBJECTIVE： To compare the effect difference of arthroplasty and internal fixation in the treatment of intertrochanteric fracture in the elderly people. METHODS： We retrieved randomized controlled studies on artificial joint replacement（total hip and femoral head replacement） and internal fixation（proximal femoral nail anti-rotation and dynamic hip screw） in the treatment of intertrochanteric fracture from 1990 to 2015. Meta-analysis was used to compare operation time, intraoperative bleeding volume, one-year postoperative Harris hip scores, and one-year postoperative complication between the arthroplasty and internal fixation. RESULTS AND CONCLUSION：（1） Twenty-one studies were included.（2） Intraoperative bleeding volume and one-year postoperative Harris hip scores were higher in the arthroplasty group than in the internal fixation group.（3） Operation time was similar between the arthroplasty and internal fixation groups.（4） Complication rate was lower in the arthroplasty group than in the internal fixation group. Incidence of complications was closed between the arthroplasty and internal fixation groups.（5） Results suggested that the effect of arthroplasty was better than internal fixation for treating intertrochanteric fracture in the elderly. However, prospective large-sample long-term randomized controlled trials are needed for verification.