髋关节置换术治疗老年股骨颈骨折的Meta分析

目的对国外有关人工髋关节置换术治疗老年股骨颈骨折的研究文献进行分析,评价老年股骨颈骨折的治疗效能。方法计算机检索PubMED和Ovid等数据库,检索时间从1991～2007年,有关人工关节置换治疗老年股骨颈骨折的文献资料。比较人工关节置换手术的死亡率、脱位、关节翻修率、关节功能。对数据进行异质性检验,用Meta分析方法对数据进行处理,估计其综合OR值和95%CI。结果共纳入10篇相关的、以半髋和全髋关节置换术对照治疗老年股骨颈骨折的文献。研究结果提示两者的死亡率之间无明显差异;脱位率和翻修率之间Q值分别为4.03和2.78,P0.1,不存在异质性,总体效应的P0.01,全髋关节置换术的脱位率高,但是翻修率低于半髋关节置换术;关节功能Harris评分的Q=23.94,P0.1,存在异质性,总体效应的P0.01,RR=0.79,OR=0.35,95%CI(0.23,0.53),全髋关节置换术后髋关节功能明显优于半髋关节置换术后的患者。结论全髋关节置换术优于半髋关节置换术,在选择关节置换治疗老年股骨颈骨折的时候,尽量行全髋关节置换术。对于不能耐受全髋关节置换手术和预期寿命低于3年的患者,则采用半髋关节置换术。

Meta-analysis on treating femoral neck fracture in the elderly with hip arthroplasty

Objective To analyze the literatures of treating femoral neck fracture in the elderly with arthroplasty,and to evaluate the value of treating femoral neck fracture in the elderly.Methods The literatures,published from 1991～2007 on treating femoral neck fracture in the elderly with arthroplasty via Pub MED and Ovid database,were collected.The mortality,dislocation,revision and Harris score after operation and check the heterogeneity were compared,and the data was dealt by meta-analysis.The OR value and 95%CI were caculated.Results A total of 10 related papers were included with the comparison on hemi-arthroplasty （HA） and total hip arthroplasty （THA）.There was no significant difference between HA and THA in mortality and no heterogeneity in dislocation and revision with the Q=4.03,2.78 respectively,and P〉0.1.The heterogeneity was confirmed with the Q=23.94,P〈0.1,and the overall OR=0.35,95%CI （0.23,0.53） 0,thus we concluded hip function was superior in the THAs rather than in the hemi-arthroplasty.Conclusions The hip function is better in the THA than in the hemi-arthroplasty.It is important to consider the practical status when choosing the suitable prosthesis,for those who can＇t undergo a long time operation or whose anticipated life span is less than five years should choose hemiarthroplasty.