摘要
背景:目前对于全髋置换和人工股骨头置换治疗股骨颈骨折的疗效和安全性尚有异议。目的:系统评价一期全髋关节置换和股骨头置换治疗60岁以上老年股骨颈骨折的疗效及安全性。方法:按照Cochrane协作网制订的检索策略进行检索,计算机检索Pub Med(1966年至2014年12月)、EMbase(1974年至2014年12月)、Cochrane图书馆(2011年第3期)、中国生物医学文献数据库(CBM,1978年至2014年12月)、中国期刊全文数据库(CNKI,1994年至2014年12月)、中文科技期刊全文数据库(VIP,1989年至2014年12月)及万方数据库(1979年至2014年12月)。纳入全髋关节置换及半髋关节置换治疗老年股骨颈骨折的文章21篇,由2名作者独立提取资料,并进行方法学质量评价。如遇分歧,协商解决。对符合纳入标准的研究用Rev Man 5.0软件进行Meta分析。结果与结论:1文献分析:纳入随机对照研究5篇,半随机对照研究3篇,回顾性队列研究13篇,共计2 250例患者;2Meta分析:一期全髋关节置换和半髋置换治疗老年股骨颈骨折相比较,在置换后脱位率、深部感染率及置换后1年内的死亡率方面差异无显著性意义(置换后脱位率:RR=1.38,95%CI:0.81-2.34;深部感染率:RR=1.12,95%CI:0.60-2.11;置换后1年的死亡率:RR=0.90,95%CI:0.69-1.18),半髋置换组的再次置换率比全髋置换高(RR=0.46,95%CI:0.32-0.66),全髋关节置换组1-4年的患侧髋关节功能Harris评分明显高于半髋关节置换(MD=5.64,95%CI:2.82-8.46);3结果说明:在身体条件允许的情况下,60岁以上老年股骨颈骨折患者一期行全髋关节置换与半髋置换相比有更好的髋关节功能,而在置换后脱位、深部感染及置换后死亡等并发症方面两者差异无显著性意义。
BACKGROUND：There are objections to the efficacy and safety of total hip arthroplasty and artificial femoral head arthroplasty in the treatment of femoral neck fracture.OBJECTIVE：To assess the efficacy and safety of one-stage total hip arthroplasty and femoral head arthroplasty for 60-year-old patients with femoral neck fractures.METHODS：According to the search strategy of Cochrane collaboration network,we searched Pub Med（1966 to December 2014）,EMbase（1974 to December 2014）,Cochrane Library（Issue 3,2011）,China Biology Medicine database（1978 to December 2014）,China National Knowledge Infrastructure（1994 to December 2014）,VIP database（1989 to December 2014）,and Wanfang Database（1979 to December 2014）.Twenty-one articles on total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures were included.Two reviewers independently evaluated the quality of the included studies and extracted the data.In case of disagreement,settlement was made by negotiation.Meta-analysis was performed by Rev Man 5.0 software in the included studies.RESULTS AND CONCLUSION：（1） Literature analysis：five randomized controlled studies,three quasi-randomized controlled studies,and thirteen retrospective cohort studies were included,containing 2 250 patients.（2） Meta-analysis：No significant difference in rate of dislocation,deep infection rate and mortality rate in 1 year after replacement was detected between total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures（dislocation rate：RR=1.38,95%CI：0.81-2.34;deep infection rate RR=1.12,95%CI：0.60-2.11;mortality rate RR=0.90,95%CI：0.69-1.18）.Reoperation rate was higher in the hemiarthroplasty group than in the total hip arthroplasty group（RR=0.46,95%CI：0.32-0.66）.Harris score on the affected side between 1 and 4 years was significantly higher in the total hip arthroplasty group than in the hemiarthroplasty group（MD=5.64,95%CI：2.82-8.46）.（3） Results suggested that if physical conditions permit,compared with hemiarthroplasty group,femoral neck fractures patients aged 60 years old in the total hip arthroplasty group had better hip function,but no significant difference was found in dislocation,deep infection and mortality between both groups.
出处
《中国组织工程研究》
CAS
北大核心
2016年第22期3328-3336,共9页
Chinese Journal of Tissue Engineering Research
