双极与单极半髋置换修复老年移位型股骨颈骨折的Meta分析  

Meta-analysis of bipolar and unipolar hemiarthroplasties for displaced femoral neck fracture in the elderly patients

作　　者：袁家钦 栾富钧[1] 陈杨帆 邓怡[1] 李波[1] Yuan Jiaqin;Luan Fujun;Chen Yangfan;Deng Yi;Li Bo(Department of Orthopedics,Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院骨科,重庆市402160

出　　处：《中国组织工程研究》2021年第18期2915-2922,共8页Chinese Journal of Tissue Engineering Research

基　　金：永川区自然科学基金(Ycstc,2015nc5006),项目负责人:栾富钧;永川区自然科学基金(Ycstc,2018nb0201),项目负责人:邓怡。

摘　　要：目的:在半髋关节置换中,内植物的选择尤为重要,其直接影响置换成功率及术后并发症。半髋关节置换可分为双极与单极半髋置换,为此,文章系统评价双极半髋置换与单极半髋置换修复老年移位型股骨颈骨折的临床疗效及安全性,为半髋置换的假体决策提供循证证据支持。方法:计算机检索PubMed、The Cochrane library、OVID、Web of Science、Scopus、中国知网、万方和维普数据库,收集国内外关于老年移位型股骨颈骨折双极和单极半髋置换治疗的临床随机对照试验文章,对纳入研究使用Cochrane手册风险评估工具进行质量评价,并采用RevMan 5.3软件对纳入研究结果数据进行Meta分析。结果:①纳入18个质量较高的临床随机对照试验,共1988例骨折患者,其中双极半髋置换组998例,单极半髋置换组990例;②与单极组相比,双极组患者死亡率、髋关节脱位、假体松动、局部感染、髋部疼痛、全身性并发症及手术相关信息差异均无显著性意义(P>0.05);③双极组术后2年的髋关节Harris评分高于单极组(MD=1.77,95%CI:0.94-2.61,P<0.001),而髋关节磨损率低于单极组(RR=0.25,95%CI:0.13-0.47,P<0.0001),但有2项研究报道双极内植物的成本可能更高。结论:与单极半髋置换比较,双极半髋置换后的老年移位型股骨颈骨折患者中髋臼磨损率更低,髋部功能恢复更好,但双极假体是否比单极假体存在更好的经济效益,未来还需进一步评价。OBJECTIVE:In hemiarthroplasty,the choice of prosthesis is particularly important,which directly affects the success rate of operation and postoperative complications.Hemiarthroplasty can be divided into bipolar hemiarthroplasty and unipolar hemiarthroplasty.This study systematically evaluated the clinical efficacy and safety of bipolar hemiarthroplasty and unipolar hemiarthroplasty in the treatment of displaced femoral neck fractures in the elderly so as to provide evidence-based support for prosthesis decision-making in hemiarthroplasty.METHODS:The databases including PubMed,The Cochrane Library,OVID,Web of Science,Scopus,China National Knowledge Infrastructure(CNKI),Wanfang Data,and VIP database were searched to collect clinical randomized controlled trials of bipolar hemiarthroplasty and unipolar hemiarthroplasty for displaced neck femoral neck fractures in elderly patients at home and abroad.The Cochrane Handbook risk assessment tool was used to evaluate the quality of the included studies.The results of the included studies were meta-analyzed by RevMan 5.3 software.RESULTS:(1)Eighteen randomized controlled clinical trials with high quality were included,with a total of 1988 fractures patients,including 998 cases in bipolar hemiarthroplasty group and 990 cases in unipolar hemiarthroplasty group.(2)There were no statistically significant differences in mortality,dislocation of prosthesis,loosening of prosthesis,local infection,hip pain,general complication,and surgical informations between bipolar hemiarthroplasty and unipolar hemiarthroplasty(P>0.05).(3)Harris score was higher in the bipolar hemiarthroplasty group than that in the unipolar hemiarthroplasty group(MD=1.77,95%CI:0.94-2.61,P<0.001).The rate of acetabular erosion in bipolar hemiarthroplasty group was lower than that in unipolar hemiarthroplasty group(RR=0.25,95%CI:0.13-0.47,P<0.0001).However,two studies have reported that bipolar implants may be more costly.CONCLUSION:Compared with unipolar hemiarthroplasty,bipolar hemiarthroplasty has lower aceta

关 键 词：骨 骨折 股骨颈 髋 半髋置换 假体 并发症 META分析 

分 类 号：R459.9[医药卫生—治疗学] R605[医药卫生—临床医学]