关节置换术治疗老年人移位型股骨颈骨折的系统评价  

Arthroplasty Compared with Internal Fixation for Displaced Femoral Neck Fractures in the Elderly: A Meta-Analysis

作　　者：薛建利 王光林[2] 夏竹青 杨天府[2] 方跃[2] 池雷霆[2] 刘雷[2] 吴刚[1] 

机构地区：[1]四川大学华西临床医学院,成都610041 [2]四川大学华西医院,成都610041

出　　处：《中国循证医学杂志》2007年第12期873-879,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价关节置换术和内固定术比较治疗老年人移位型股骨颈骨折的疗效与安全性。方法计算机检索MEDLINE（1966-2006年9月），EMbase（1966～2006年9月），Cochrane图书馆（2006年第4期）、CMB（截止2006年9月），CNKI（截止2006年9月），收集所有关节置换术与内固定术比较治疗老年人（〉60岁）移位型股骨颈骨折的随机对照试验，筛选出符合纳入标准的文献，对其进行严格的质量评价，利用RevMan4．2．8软件对纳入研究结果进行Meta分析。结果共检索到相关文献228篇，最终纳入15个RCT，共255例。Meta分析结果显示，关节置换术和内固定术比较，术后1年病死率差异无统计学意义[RR合并=1．05，95％CI（0．89，1．23）]；但内固定组术后2年再手术率[RR合并=0．12，95％CI（0．08，0．18）]、5年再手术率[RR合并=0．11，95％CI（0．06，0．22）]、2年主要并发症[RR合并=0．15，95％CI（0．09，0．23）]及5年主要并发症[RR合并：0．18，95％CI（0．11,0．30）1均高于关节置换组。结论老年人移位型股骨颈骨折选择关节置换术治疗可明显降低术后再次手术率及主要并发症；但与内固定术比较，1年后病死率无差异。Objective To compare the effects of arthroplasty with that of intenal fixation for displaced femoral neck fractures in the elderly. Methods We searched for all randomized controlled trials and quasi-randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching MEDLINE（ 1966 to September, 2006）,EMbase（1966 to September, 2006）, Cochrane Library（ Issue 4 2006）, CBM（ up to September, 2006） and CNKI （September, 2006） and handsearching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using The Cochrane Collaboration＇s RevMan 4.2.8 software. The quality of the trials was assessed. And meta-analysis was conducted by using RevMan4.2.8 software. Results A total of 228 papers were retrieved, but only 15 published randomized controlled trials involving a total of 2 254 patients were suitable for inclusion in the review. Based on the meta-analyses, hip arthroplasty showed obvious advantages over internal fixation in terms of the incidences of major complications after 2 years （RR 0.15 ; 95%CI 0.09 to 0.23） and after 5 years （RR 0.18 ; 95%CI 0.11 to 0.30） as well as re-operation rate （RR0.12 ; 95%CI 0.08 to 0.18） after 2 years, and after 5 years （RR0.11 ; 95%CI 0.06 to 0.22）, there was an advantage to performing hip asthroplasty. After one year, the mortality was the same in both groups with RR 1.05 and 95%CI 0.89 to 1.23. Conclusion There is an evidence base to support arthroplasty as a treatment for displaced femoral neck fractures in the elderly. Arthroplasty can not only decrease the rate of re-operation, but can also reduce the incidence of complications, with similar one-year mortality when compared to internal fixation.

关 键 词：关节置换术 内固定术 股骨颈骨折 META分析 系统评价 

分 类 号：R687.4[医药卫生—骨科学]