关节置换与植入物内固定治疗老年移位型股骨颈骨折的系统评价  

Systematic review of arthroplasty combined with internal fixation for displaced femoral neck fractures in elderly patients

作　　者：陈跃平[1] 高辉[1] 陈亮[1] 罗东方[1] 尹庆水[2] 

机构地区：[1]广西中医学院附属瑞康医院骨科,广西壮族自治区南宁市530011 [2]解放军广州军区广州总医院骨科医院,广东省广州市510010

出　　处：《中国组织工程研究》2012年第9期1656-1660,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:老年移位型股骨颈骨折治疗常需要内固定或人工髋关节置换,两种术式如何选择一直是骨科医生争论的焦点。目的:对髋关节置换与内固定治疗老年移位型股骨颈骨折的疗效和安全性进行系统评价。方法:计算机检索Cochrane图书馆(2011年第5期)、MEDLINE(1966-01/2011-05)、EMbase(1984-01/2011-05)、CNKI(1979-01/2011-05)。收集所有髋关节置换与内固定比较治疗老年人(>60岁)移位型股骨颈骨折的随机对照试验(RCT),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Cochrane协作网提供的RevMan5.1.2软件对纳入研究结果进行Meta分析,使用GRADEpro version3.2.2软件对纳入研究进行证据评级。结果与结论:共检索到相关文献87篇,最终纳入13个RCT,共2436例患者。Meta分析结果显示,随访2年、10年或10年以上病死率,关节置换和内固定组比较差异均无显著意义。随访2年、10年或10年以上再手术率及并发症,关节置换组均显著低于内固定组。提示无论短期还是长期选择关节置换治疗老年人移位型股骨颈骨折可明显降低术后再次手术率及主要并发症。BACKGROUND：Treatment of femoral neck fracture in elderly patients is always through internal fixation or arthroplasty,but how to choose the two procedures for the treatment is the debate focus of orthopedic surgeons.OBJECTIVE：To review the clinical outcomes and safety between arthroplasty and internal fixation in treatment of elderly patients with femoral neck fracture.METHODS：Cochrane central register of controlled trials （fifth book in 2011）,MEDLINE （1966-01/2011-05）,EMbase （1984-01/2011-05） and CNKI （1979-01/2011-05） were （〉 60 years） searched.Only randomized clinical trials that compared arthroplasty with internal fixation for the treatment of femoral neck fracture in the elderly （〉60 years） were included.The analysis was performed with software RevMan5.1.2 from the Cochrane collaboration.The study was rated by GRADEpro version3.2.2 Software.RESULTS AND CONCLUSION：There were 87 potentially relevant papers and 13 published studies met all the inclusion criteria and proved eligible for this investigation at last.A total of 2 436 patients were included.The meta-analysis showed there was no significant difference of the mortality between the arthroplasty group and the internal fixation group at 2,10 or over 10 years follow-up.Reoperation rate and surgical complication at 2,10 or over 10 years follow-up in the arthroplasty group were significantly lower than those of the internal fixation group.It is indicated that whether short or long-term option arthroplasty for displaced femoral neck fractures in the elderly can significantly reduce the reoperation rate and major complications.

关 键 词：更多还原 股骨颈骨折 关节置换 内固定 系统评价 META分析 

分 类 号：R318[医药卫生—生物医学工程]