骨替代物加强内固定与单纯内固定治疗老年股骨近端骨折疗效的Meta分析

Bone substitutes augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly:a meta-analysis

目的 ：系统评价骨替代物加强内固定与单纯内固定治疗老年股骨近端骨折的临床疗效。方法 ：采用主题词和自由词（或主题词和关键词）结合的方法,通过计算机检索Pubmed、考克兰数据库（Cochrane databases）、中国知网数据库（CNKI）,检索起止时间为从建库至2015年8月。收集骨替代物加强内固定与单纯内固定治疗老年股骨近端骨折的随机对照研究和准随机对照研究。选择术后再移位、再手术率、并发症（感染和骨折不连）、功能结果、生活质量评分和肌肉力量作为结局指标。计数资料采用风险差异及95%可信区间,计量资料采用均数差和95%可信区间。当同一计量资料在不同的研究中被不同标准评估时,采用其标准均值差及95%可信区间。按照考克兰协作网推荐的方法进行系统评价。结果：共纳入11项研究677例患者。Meta分析结果显示：骨替代物加强内固定组术后较少发生再移位[SMD=-0.75,95%CI（-1.03,-0.47）],并可获得更好的功能[SMD=0.40,95%CI（0.20,-0.59）]。两组患者再手术率[RD=0.02,95%CI（-0.05,-0.09）]、术后1周疼痛[SMD=-1.79,95%CI（-13.55,-9.96）]、术后6~8周疼痛[SMD=-7.24,95%CI（-20.07,-5.59）]、术后12周疼痛[MD=-0.32,95%CI（-4.19,-3.55）],肌力[MD=1.25,95%CI（-6.98,-9.48）]、骨折不愈合[RD=0.02,95%CI（-0.01,-0.05）]、术后感染[MD=0.01,95%CI（-0.03,-0.04）]等方面比较无明显差异。结论：与单纯内固定治疗相比,采用骨替代物加强内固定治疗老年股骨近端骨折术后较少发生再移位,且可获得较好的功能恢复。

Objective：To systematically review the effectiveness of bone substitute augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly. Methods： Subjectterm and keywords were searched from Pubmed, Cochrane databases and CNKI from database foundation to August 2015. Randomized controlled studies and qusi-randomized controlled studies on bone substitutes augmentation combined with internal fixation versus internal fixation alone for the treatment of proximal femoral fractures in the elderly were chosen. Postoperative re-displacement, reoperation rate ,complications （infection and bone ununion） ,functional outcome ,quality of life scores and muscle strength were seen as outcome indicators. Enumeration data werestatistical analyzed by risk difference and 95% confidence interval. Measurement data were analyzed by standardized mean difference and 95% confidence interval. If the same measurement data were evaluated by different standards in different studies, standardized mean differences and 95% confidence interval were used. The methods of statistical analysis were used by Cochrane databases. Results：Eleven RCTs （677 patients） were included. Metaanalysis results indicated that bone substitutes augmentation combined with internal fixation occurred fewer re-displacement [ SMD=-0.75,95 %CI （ - 1.03, -0.47 ） ] and obtained better function [ SMD=0.40,95%CI （0.20,0.59） ]. While there were no significant differences in reoperation rate [ RD=0.02,95% CI （-0.05, -0.09） ], pain at 1 week after operation [ MD=- 1.79,95%CI （- 13.55,-9.96） ] ,pain ranged from 6 to 8 weeks [MD=-7.24,95% CI （-20.07,-5.59）] ,postoperative pain at 12 weeks [MD=- 0.32,95%CI（-4.19,-3.55） ] ,muscle strength [MD=1.25,95% CI（-6.98,-9.48）] ,bone ununion [RD=0.02,95% CI（-0.01, -0.05） ] and postoperative complications [ MD=0.01,95% CI （-0.03, -0.04） ]. Conclusion： Compared with single internal fixation, bone substitutes augmentation combined with internal fixation for the treatment of proximal femoral fractures in the elderly less occur re-displacement and could obtain better functional recovery.