双动全髋与半髋置换治疗老年移位型股骨颈骨折的Meta分析

Meta analysis of dual-mobility total hip arthroplasty and hemiarthroplasty for the treatment of displaced neck femoral neck fractures in elderly patients

目的系统评价比较双动全髋关节置换(dual-mobility total hip arthroplasty,DM-THA)与半髋关节置换(hemiarthroplasty,HA)治疗老年移位型股骨颈骨折的临床疗效和安全性。方法计算机检索PubMed、The Cochrane library、Web of Science、Medline、Embase、中国知网(CNKI)、万方和维普数据库。检索时间至2021年12月,提取纳入研究的基本信息、髋关节脱位率、再次手术率、1年病死率、髋部功能Harris评分、假体周围骨折率、术后感染率、假体松动率以及手术相关信息等数据资料,对其进行质量评价分析,并采用RevMan 5.3软件对纳入研究结果进行Meta分析。结果共纳入11篇文献,共纳入1604例。其中随机对照试验2篇,病例对照研究9篇。DM-THA组786例,HA组818例。DM-THA与HA相比,假体周围骨折、术后感染、假体松动、住院时间等差异无统计学意义。DM-THA组的髋关节脱位率低于HA组,OR=0.26,95%CI(0.15,0.45),P<0.00001;再次手术率低于HA组,OR=0.41,95%CI(0.26,0.62),P<0.00001;1年病死率低于HA组,OR=0.56,95%CI(0.38,0.82),P=0.003;髋部功能Harris评分则高于HA组,MD=6.60,95%CI(4.73,8.48),P<0.00001。DM-THA组所用的手术时间多于HA组,MD=7.96,95%CI(3.24,12.69),P=0.001,术中出血量也多于HA组,MD=67.1,95%CI(32.26,101.94),P=0.0002。结论DM-THA较于HA在术后髋关节脱位率、再次手术率、1年病死率、术后Harris评分等方面有明显的优势,而手术时间、术中出血量却明显多于HA组,在假体周围骨折、术后感染率、假体松动率、患者住院时间等方面两者差异无统计学意义。

Objective To investigate the efficacy and safety of dual-mobility total hip arthroplasty and hemiarthroplasty for the treatment of displaced neck femoral neck fractures in elderly patients,and to systematically evaluate the differences between the two internal fixation methods.Methods The databases including PubMed,The Cochrane Library,Web of Science,Medline,Embase,China National Knowledge Infrastructure(CNKI),WanFang Data,VIP database for Chinese Technical Periodicals were searched through Internet.Basic information of the selected studies until December 2021,including dislocations of hip,reoperation rate,one-year mortality,hip Harris score,periprosthetic fracture,postoperative infection,loosening of prosthesis and surgical information were analyzed for quality evaluation.RevMan 5.3 software was used to conduct Meta analysis.Results The analysis included 1604 patients(785 cases in DM-THA group and 818 cases in HA group)from 2 randomized controlled trials and 9 comparative studies.There were no statistically significant differences in periprosthetic fracture,postoperative infection,loosening of prosthesis and patient hospitalization time between DM-THA and HA.Pooled Meta-analysis revealed that DM-THA group had lower dislocation rate of hip[OR=0.26,95%CI(0.15,0.45),P<0.00001],reoperation rate[OR=0.41,95%CI(0.26,0.62),P<0.00001]and one-year mortality[OR=0.56,95%CI(0.38,0.82),P=0.003].The hip Harris score in DM-THA group was higher than that in HA group[MD=6.60,95%CI(4.73,8.48),P<0.00001].The operation time[MD=7.96,95%CI(3.24,12.69),P=0.001]and blood loss[MD=67.1,95%CI(32.26,101.94),P=0.0002]in DM-THA group were higher than those in HA group.Conclusions Compared with HA,DM-THA has obvious advantages in terms of postoperative hip dislocation rate,reoperation rate,one-year mortality rate,postoperative Harris score,etc.,while the operation time and intraoperative blood loss are significantly more than that of the HA group.There are no statistical differences between the two in terms of periprosthetic fracture,postoperative infection,loosening of prosthesis and hospitalization time.