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老年股骨颈骨折不同治疗方式比较的meta分析

Comparing different treatments for femoral neck fracture of displacement type in the elderly: a meta analysis

摘要:

目的 评价内固定术和全髋关节置换术对老年移位型股骨颈骨折患者的疗效与安全性.方法 计算机检索PubMed数据库,EMBase数据库,COCHRAN图书馆,CMB数据库,CNKI数据库,MEDLINE数据库.收集符合纳入排除标准的随机对照试验,使用Revman 5.2.6软件对所选文献进行meta分析.结果 最终选出6个随机对照试验,共包含病例627例,其中内固定组286例,全髋关节置换组341例.通过分析得出,内固定组患者术后髋关节Harris评分(反映生活质量)要差于全髋关节置换组,差异存在统计学意义(RR =0.82,95% CI:0.72 ~0.93,P<0.05);在手术的安全性方面,内固定组患者术后再手术率及术后主要并发症发生率均要高于全髋关节置换组患者,差异存在统计学意义(RR =5.81,95% CI:3.09 ~ 10.95,P<0.05)和(RR =3.60,95% CI:2.29 ~5.67,P<0.05).而在术后1和5年的病死率方面,两者的差异无统计学意义(均P >0.05).结论 对于老年移位型股骨颈骨折患者,两种手术方式的术后病死率无明显差异,但内固定术后的患者生活质量以及手术的安全性均要差于全髋关节置换术.

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abstracts:

Objective To compare the effects and security between internal fixation and total hip arthroplasty for the patients in elderly with femoral neck fracture of displacement type through a meta analysis.Methods Studies on comparison between internal fixation and total hip arthroplasty for the patients in the elderly with femoral neck fracture of displacement type were identified from PubMed database,EMBase database,COCHRANE library,CMB database,CNKI database and MEDLINE database.Data analysis were performed using Revman 5.2.6 (the Cochrane Collaboration).Results Six published randomized controlled trials including 627 patients were suitable for the review,286 cases in internal fixation group and 341 cases in total hip arthroplasty group.The results of meta analysis indicated that statistically significant difference were observed between the two groups in the quality of life which was reflected by the Harris scale(RR =0.82,95% CI:0.72-0.93,P < 0.05),the reoperation rate (RR =5.81,95% CI:3.09-10.95,P < 0.05) and the major complications rate (RR =3.60,95 % CI:2.29-5.67,P < 0.05) postoperatively.There were no difference in the mortality at 1 year and 5 years postoperatively(P > 0.05).Conclusions For the patients with femoral neck fracture of displacement type in the elderly,there is no statistical difference between two groups in the mortality postoperatively.The quality of life and the security of operation in internal fixation group is worse than the total hip arthroplasty group.

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