直接前入路与其他入路行人工股骨头置换治疗老年股骨颈骨折患者疗效的Meta分析

Meta analysis of direct anterior approach and other approaches for hemiarthroplasty in elderly patients with femoral neck fracture

目的:用Meta分析的方法对国内外已发表较高质量的有关直接前入路(DAA)与其他入路行人工股骨头置换治疗老年股骨颈骨折患者的临床疗效进行系统评价。方法:计算机检索Cochrane Library、PubMed、EMBASE、Web of science、万方、中国知网数据库。检索中英文公开发表的文献。检索时间为建库至2019年5月20日,由2位作者严格按照纳入和排除标准独立筛选文献,提取资料和评价纳入研究质量。应用Cochrane关于RCT偏倚风险评估工具评价纳入的RCT文献质量。non-RCT采用NOS量表评价文献质量。采用Cochrane协作网提供的RevMan 5.3软件对纳入研究结果进行Meta分析,并对数据进行异质性检验。结果:最终纳入文献9篇,总样本量901例。其中DAA组429例,对照组472例。DAA组与对后侧、后外侧入路亚组比较,在脱位率上差异有统计学意义[OR=0.19,95%CI(0.06,0.61),P=0.005],DAA组脱位率更低。与外侧、前外侧入路亚组比较,脱位率无明显差异[OR=1.08,95%CI(0.20,5.76),P=0.93]。在感染率[OR=1.07,95%CI(0.47,2.43),P=0.88]、围手术期骨折率[OR=0.95,95%CI(0.36,2.50),P=0.92]、再手术率[OR=0.76,95%CI(0.30,1.89),P=0.55]、总并发症发生率[OR=0.88,95%CI(0.63,1.22),P=0.44]、死亡率[OR=1.33,95%CI(0.84,2.11),P=0.23]、手术时间[MD=1.43,95%CI(-5.85,8.71),P=0.70]上比较差异无统计学意义(P>0.05)。结论:基于有限的资料,直接前入路较后侧、后外侧入路行人工股骨头置换治疗老年股骨颈骨折,术后脱位率显著性降低,与外侧、前外侧入路脱位率无显著性差异。

Objective:To systematically evaluate the clinical efficacy of high quality direct anterior approach(DAA)and other approaches for the treatment of elderly patients with femoral neck fracture.Methods:Literatures published in English or Chinese about the direct anterior approach and other approaches for hemiarthroplasty in femoral neck fracture were searched on Cochrane Library,PubMed,EMBASE,Web of science,Wanfang,CNKI databases from their establishment to May 2019.According to the inclusion and exclusion criteria,two researchers independently screened the literatures,and extracted the data.The quality of RCT were evaluated by Cochrane Risk of Bias Assessment Tool,and non RCT were evaluated by the NOS scale.Meta analysis was performed using the RevMan 5.3 software.Results:A total of 9 articles were included with 901 cases,in which 429 cases used DAA,and 472 used other approaches.DAA had a significantly lower dislocation rate compared to subgroup of posterior and posterolateral approach[OR=0.19,95%CI(0.06,0.61),P=0.005].No significant differences were found between DAA group and subgroup of direct lateral and anterolateral approach[OR=1.08,95%CI(0.20,5.76),P=0.93].Also there were no relevant differences between the DAA group and control in infection rate[OR=1.07,95%CI(0.47,2.43),P=0.88],perioperative fracture rate[OR=0.95,95%CI(0.36,2.50),P=0.92],re operation rate[OR=0.76,95%CI(0.30,1.89),P=0.55],overall complication rate[OR=0.88,95%CI(0.63,1.22),P=0.44],mortality[OR=1.33,95%CI(0.84,2.11),P=0.23],operative time[MD=1.43,95%CI(-5.85,8.71),P=0.70].Conclusion:The current evidence indicates that the DAA was associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty.There was no significant difference in dislocation rate with the lateral and anterolateral approach.