全髋与半髋关节置换术治疗老年移位型股骨颈骨折疗效的Meta分析

Meta-analysis of the curative effect of total hip arthroplasty and hemiarthroplasty in the treatment of displaced femoral neck fracture in elderly patients

目的比较全髋关节置换术(THA)与半髋关节置换术(HA)治疗老年患者股骨颈骨折的疗效,为老年移位型股骨颈骨折术式的选择提供循证医学证据。方法通过检索Cochrane library、PubMed、EBSCO、CSA、中国知网、维普、万方数据库,收集所有关于THA与HA治疗股骨颈骨折的文献,按纳入与排除标准筛选文献,评价纳入文献质量后提取资料,采用Review Manager 5.3软件对所有结果指标进行分析。结果共纳入32篇文献,其中采用THA的患者有1644例,采用HA的患者有1629例。结果显示THA组手术时间长于HA,THA组术中出血量及术后引流量多于HA组,差异均有统计学意义(P<0.05);但THA组术后关节功能恢复时间及完全负重时间短于HA组,术后Harris评分及优良率高于HA组,术后并发症总发生率低于HA组,术后髋臼磨损、下肢深静脉血栓、切口感染、髋部疼痛及假体松动的发生率低于HA组,差异均有统计学意义(P<0.05)。结论对于老年移位型股骨颈骨折的治疗,虽然THA手术时间较长,术中出血量及术后引流量较多,但是其在患者术后关节功能恢复时间、完全负重时间及术后并发症发生率方面明显优于HA。

Objective To compare the efficacy of total hip arthroplasty(THA)and hemiarthroplasty(HA)in the treatment of displaced femoral neck fracture in elderly patients,and to provide evidence-based medical evidence for the selection of surgical procedures for displaced femoral neck fracture in the elderly.Methods By searching Cochrane library,PubMed,EBSCO,CSA,China National Knowledge Infrastructure,VIP and Wanfang databases,all the literatures about THA and HA in the treatment of femoral neck fracture were collected.The literatures were screened according to the inclusion and exclusion criteria,and the data were extracted after evaluating the quality of the included literatures.Review Manager 5.3 software was used to analyze all the outcome indicators.Results A total of 32 literatures were included,including 1644 patients underwent THA and 1629 patients underwent HA.The results showed that the operation time of the THA group was longer than that of the HA group,and the intraoperative blood loss and postoperative drainage volume of the THA group were more than those of the HA group,with statistically significant differences(P<0.05).However,the postoperative recovery time of joint function and full weight-bearing time of the THA group were shorter than those of the HA group,the postoperative Harris score and excellent and good rate were higher than those of the HA group,the total incidence of postoperative complications was lower than that of the HA group,and the incidence of postoperative acetabular wear,lower extremity deep vein thrombosis,incision infection,hip pain and prosthesis loosening were lower than those of the HA group,all the differences were statistically significant(P<0.05).Conclusion For the treatment of elderly displaced femoral neck fracture,THA has a longer operation time,more intraoperative blood loss and postoperative drainage volume.However,it is significantly better than HA in terms of postoperative recovery time of joint function,full weight-bearing time and incidence of postoperative complications.