我国高龄不稳定型转子间骨折经人工关节置换术与内固定术治疗的Meta分析

目的：系统评价我国人工关节置换术和内固定术比较治疗高龄不稳定型股骨转子间骨折的疗效与安全性。方法：计算机检索EMBASE、PubMed、Cochrane图书馆、CBM、VIP及CNKI，收集所有我国人工关节置换术和内固定术比较治疗高龄（≥70岁）不稳定型股骨转子间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RevMan4．2．10软件对纳入研究结果进行Meta分析。结果：共检索到相关文献199篇，最终纳入10个RCT，共797例。Meta分析结果显示，关节置换术较内固定术手术操作时间短，术中出血量及术中术后输血总量少，内科及内植物相关并发症发生率低，术后卧床时间短，且差异有统计学意义。术后末次随访关节功能评价无统计学意义。结论：人工关节置换术可以作为高龄老年不稳定型股骨转子间骨折的治疗方法之一．但不能代替内固定治疗。该研究仍需长期、同质、大量样本进行观察评价。

An Meta analysis of arthroplasty compared with internal fixation for unstable intertroehanteric hip fractures of aged Patients in China

Objective： To compare the effects of arthroplasty with that of intenal fixation for unstable intertrochanteric hip fractures of aged patients in China. Methods：We searched for all randomized controlled trials of hip arthroplasty versus internal fixation for unstable intertrochanteric hip fractures of aged patients by electronically searching EMBASE, PubMed, Cochrane Library, CBM, VIPand CNKI.The quality of the trials was assessed and Meta-analyses were conducted using The Cochrane Collaboration＇ s RevMan 4.2.10 software. Results： A total of 199 papers were retrieved, but only 10 published randomized controlled trials involving a total of 797 patients were suitable for inclusion. Statistically significant differences were observed in operation time, blood loss, blood transfusion, complication of general medical and implantation, time of bedside activities and mortality of post-operation after 1 year. There was an advantage to performing hip asthroplasty. But no significant difference was noted in patient excellency of the hip joint. Conclusion：There is an evidence base to support arthroplasty as a treatment for unstable intertrochanteric hip fractures of aged patients. But internal fixation can not be substituted by arthroplasty. Large-scale, long-term and appropriately designed RCTs are required.