微创与传统全髋关节置换术临床疗效对比的系统评价

目的 :系统评价微创全髋关节置换术与传统全髋关节置换术治疗髋关节疾病的疗效。方法 :计算机检索Pub Med、Cochrane Library、EMbase、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方期刊全文数据库(Wanfang Data)的微创全髋关节置换术与传统全髋关节置换术治疗髋关节疾病的随机对照试验,时间为建库至2014年6月。按照纳入与排除标准独立筛选文献、提取资料,按Cochrane Handbook 5.0推荐的"偏倚风险评估"工具对纳入研究进行方法学质量评价,采用Rev Man 5.3软件进行Meta分析。比较两组术后3个月Harris髋关节评分、术后1年Harris髋关节评分、术后6周WOMAC评分、术后6周Oxford评分、术后8 h红细胞压积、术后48 h红细胞压积及血红蛋白量、术后髋内翻及髋关节脱位发生率和股骨偏心距增加值。结果 :共纳入13个随机对照试验,共1 213例患者(1 284髋),其中微创全髋关节置换术631髋,传统全髋关节置换术653髋。Meta分析结果显示:术后3个月Harris髋关节评分[MD=8.37,95%CI(6.02,10.72)],术后48 h红细胞压积[MD=0.02,95%CI(0.01,0.03)],术后48 h血红蛋白量[MD=0.50,95%CI(0.16,0.85)],改善股骨偏心距[MD=0.30,95%CI(0.04,0.56)]方面传统全髋关节置换术优于微创全髋关节置换术,差异有统计学意义;术后1年Harris髋关节评分[MD=3.26,95%CI(-3.25,9.76)],术后6周WOMAC评分[MD=-0.53,95%CI(-3.67,2.60)],术后6周Oxford评分[MD=1.34,95%CI(-3.46,6.13)],术后8 h红细胞压积[MD=-0.01,95%CI(-0.02,0.00)],髋内翻发生率[RR=0.82,95%CI(0.45,1.52)],髋关节脱位发生率[RR=1.40,95%CI(0.48,4.12)]方面两组差异无统计学意义。结论 :传统全髋关节置换术可带来更小的创伤和失血,其术后早期疗效优于微创全髋关节置换术;两种术式在术后并发症发生率方面并无差异。     

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。     

85岁以上高龄患者髋关节置换方式选择及疗效比较

目的总结85岁以上患者初次髋关节置换的手术体会,分别比较全髋与半髋置换、生物型半髋与骨水泥型半髋假体的不同疗效。方法对48例患者行髋关节置换,其中全髋置换14例,半髋置换34例(生物型23例,骨水泥型11例)。统计手术时间、术中及术后出血量。术后随访行Harris评分及X线评估。结果全髋组手术时间、出血量均高于半髋组。术后3个月时半髋与全髋组及生物型半髋与骨水泥型半髋组间Harris评分差异均无统计学意义(P0.05)。13例3个月后失访,共35例获最终随访,平均随访28(6～78)个月,最终随访时全髋组与半髋组Harris评分为(87.9±6.2)分与(82.4±5.8)分,两组间差异有统计学意义(P=0.042)。无假体松动、感染病例。结论 85岁以上患者同样可以考虑全髋关节置换,生物型与骨水泥型置换疗效相似但生物型假体更安全。     

全髋和半髋关节置换治疗老年股骨颈骨折的疗效比较

目的 比较全髋关节置换和半髋关节置换治疗老年GardenⅢ、Ⅳ型股骨颈骨折的疗效。方法 将86例老年股骨颈骨折患者根据治疗方法不同分为全髋组(采用全髋关节置换术,43例)和半髋组(采用半髋关节置换术,43例)。比较两组手术时间、术中出血量、输血例数、住院时间、术后并发症。采用髋关节Harris评分评价髋关节功能。结果 患者均获得随访,时间3～12个月。手术时间、术中出血量全髋组长(多)于半髋组(P 0. 05)。术后髋关节功能优良率全髋组高于半髋组(P 0. 05)。术后并发症发生率全髋组低于半髋组(P 0. 05)。两组住院时间、输血例数比较差异均无统计学意义(P 0. 05)。结论 全髋关节置换与半髋关节置换治疗老年股骨颈骨折各有优劣,需把握合适的适应证,根据患者的身体条件和对术后功能需求选择合适的手术方案。     

羟基磷灰石涂层股骨柄初次全髋关节置换随机对照试验的meta分析

目的 评价羟基磷灰石涂层与非羟基磷灰石涂层股骨柄初次全髋关节置换术的临床和放射学结果差异.方法 计算机检索MEDLINE、Embase、Cochrane图书馆、中国生物医学文献数据库,搜集比较羟基磷灰石涂层与非羟基磷灰石涂层股骨柄初次全髋关节置换术的随机对照试验,临床结果评价指标包括Harris评分、大腿疼痛发生率,放射学结果评价指标包括假体周围点焊和透亮线现象、异位骨化.采用RevMan 5.0软件对纳入试验数据进行meta分析.结果 共纳入10项研究917髋,其中HA组464髋,非HA组453髋.Meta合并结果两组术后Harris评分比较差异无统计学意义(WMD=3.04,95％ CI:-4.47～ 10.54,P=0.43),术后大腿疼痛发生率比较差异有统计学意义(RR=0.56,95％CI:0.33 ～0.94,P=0.03),术后假体周围点焊现象(RR=1.01,95％ CI:0.91～ 1.11,P=0.91)、透亮线现象(RR =0.99,95％ CI:0.88 ～ 1.11,P=0.83)和异位骨化发生率(RR =0.97,95％ CI:0.77 ～ 1.21,P=0.77),差异均无统计学意义(P＞0.05).结论 羟基磷灰石涂层股骨柄初次全髋关节置换在临床和放射学结果上并无明显优势,目前尚无充足证据说明可降低术后大腿痛的发生率.     

人工股骨头置换与内固定治疗老年不稳定型股骨粗隆间骨折的系统评价

[目的]系统评价人工股骨头置换与内固定治疗老年不稳定型股骨粗隆间骨折的疗效与安全性。[方法]计算机检索中国知网(CNKI:1960²013.4)、万方数据库(19982013.4)、万方数据库(1998²013.4)、维普数据库(19892013.4)、维普数据库(1989²013.4)、中国生物医学数据库及超星电子图书。手工检索国内近5年来发表于各骨科杂志及相关杂志的相关文献:《中华关节外科杂志》《中华创伤杂志》《中华骨科杂志》《中国矫形外科杂志》《中国全科医学杂志》《中国骨与关节损伤杂志》等等,收集所有相关人工股骨头置换与内固定治疗老年不稳定型股骨粗隆间骨折的随机对照试验及半随机对照试验,采用Cochrane协作网提供的软件RevMan 5.0进行系统评价。[结果]共纳入35篇随机对照试验及半随机对照试验,共2 739例患者,纳入研究质量评价结果为B级27篇,C级8篇。系统评价结果显示,与传统的内固定组相比,人工股骨头置换组术后下床负重时间短[MD=-32.66,95%CI(-40.16,-25.15),P<0.05];术后并发症少[RR=0.47,95%CI(0.37,0.60),P<0.05];术后优良率高[RR=1.18,95%CI(1.07,1.31),P=0.001<0.05],但在手术时间方面差异无统计学意义。[结论]与传统的内固定相比,人工股骨头置换术在治疗老年不稳定型股骨粗隆间骨折方面具有术后下床负重时间短、并发症少及优良率高的优点,故应该首选。但由于本系统评价存在一定的局限性及偏倚,可能造成结果的可靠性降低,故还需要大量严格的、大样本量的、多中心性的,并且采用正确的随机原则、盲法、分配隐藏等文献研究来进一步论证。     

全髋关节和半髋关节置换术治疗股骨颈骨折的比较

目的评价全髋关节置换术和半髋关节置换术治疗股骨颈骨折的临床疗效并进行比较。方法回顾性分析53例（54髋）股骨颈骨折患者，男22例，女31例，年龄52—89岁（平均71岁），分别行全髋和半髋关节置换治疗，随访1—9年，平均5．4年。对其住院时间、手术时间、手术出血、术后失血、输血总量、有无并发症、术后功能恢复情况等作比较。结果全髋置换组手术时间明显长于半髋置换组（P〈0．05）；术中出血量、术后出血量、输血总量、住院时间长短均无明显统计学差异（P〉0．1）；术后并发症无明显统计学差异；半髋置换患者术后大腿痛明显多于全髋置换（P〈0．05）；术后功能恢复情况无明显统计学差异。结论半髋和全髋置换治疗股骨颈骨折的效果是满意的，对身体条件好，术后活动较多的或较为年轻的患者宜选择全髋关节置换术。     

全髋与半髋关节置换治疗股骨颈骨折的临床效果

目的探讨全髋与半髋关节置换治疗股骨颈骨折的临床效果。方法将220例股骨颈骨折患者根据治疗方法不同分成全髋关节置换组(110例)和半髋关节置换组(110例)。比较两组手术情况和并发症发生率,采用Harris髋关节功能评分评价疗效。结果患者均获得随访,时间6～12个月。手术时间、术中出血量、术后下床时间全髋关节置换组均长(多)于半髋关节置换组(P 0. 05)。术后3个月髋关节功能优良率全髋关节置换组为91. 82%,高于半髋关节置换组的82. 73%(P 0. 05)。并发症发生率全髋关节置换组为18. 18%,半髋关节置换组为5. 45%,差异有统计学意义(P 0. 05)。结论全髋与半髋关节置换治疗股骨颈骨折的临床效果均较为理想,可根据患者情况选择不同方式。     

全髋和半髋置换治疗老年股骨颈骨折的比较研究

目的比较半髋关节置换与全髋关节置换治疗老年移位股骨颈骨折的安全性及有效性差异。方法1999年2月至2007年1月在我院行髋关节置换的老年移位股骨颈骨折（GardenⅢ、Ⅳ型）患者共133例,其中全髋关节置换78例,半髋关节置换55例。收集病例资料并进行随访,随访内容包括安全性评估指标及有效性评估指标,具体为术后并发症、术后疼痛率、翻修率及术后髋关节功能评分,统计学分析两种术式的安全性及有效性有无差异。结果8例失访,7例在随访过程中死亡,118例完成随访,随访时间2～10年,平均5．1年。全髋置换组术后并发症发生率高于半髋置换组,翻修率低于半髋置换组,但均无统计学差异;全髋置换组术后疼痛率低于半髋置换组,有统计学差异;术后髋关节功能评分高于半髋置换组,有显著统计学差异。结论全髋关节置换术的安全性和有效性均高于半髋关节置换术,应为首选措施。     

髋关节表面置换术治疗先天性髋关节发育不良

目的 探讨髋关节表面置换术治疗先天性髋关节发育不良的临床疗效.方法 2005年3月至2006年12月对34例(37髋)先天性髋关节发育不良患者行髋关节表面置换术,其中Crowe Ⅰ型28例(31髋)、Crowe Ⅱ型6例(6髋).其中女性29例(32髋),男性5例(5髋),患者平均年龄45岁(26～57岁).患者在术后6周、3个月、1年,及此后每年1次进行随访,接受放射学及临床评价.术前患者Harris评分平均35分,髋关节屈曲101°,外展24°,内收15°,术前12例患者双下肢等长.结果 34例患者中,3例(3髋)患者术中改行全髋关节置换术.31例(34髋)行表面置换.31例表面置换患者平均随访时间21.4个月(12～33个月).患者术后最后一次随访平均为94分(82～100分),与术前比较差异具有统计学意义(P＜0.01).术后髋关节屈曲改善至133°,外展48°,内收26°.术后23例患者双下肢等长.患者股骨及髋臼假体周围均未见透亮线,髋臼假体的平均外展角为43°(40°～53°),股骨假体柄干角平均为139°(130°～145°).结论 本组患者短期随访结果令人满意,良好的手术技术和手术适应证的严格掌握是先天性髋关节发育不良患者手术成功的关键.     

关节置换术与内固定术治疗老年人移位型股骨颈骨折的系统评价

目的 系统评价关节置换术和内固定术治疗老年人移位型股骨颈骨折的疗效. 方法 计算机检索Medline(1966年1月至2009年9月),荷兰医学文摘(1966年1月至2009年9月),Cochrane图书馆(2008年第1期)、中国生物医学文献数据库(截止2009年9月),中国学术期刊网(截止2009年9月),手工检索相关参考文献及中文期刊,收集所有关节置换术与内固定术比较治疗老年人(>60岁)移位型股骨颈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后应用RevMan4.2.8软件进行Meta分析. 结果 共纳入18个RCT,包含2561例患者.Meta分析结果显示,关节置换术术后2年再手术率(RR=0.13,95%CI 0.09～0.17)、5年再手术率(RR=0.11,95%CI 0.06～0.22)及术后2年主要并发症发生率(RR=0.20,95% CI 0.15～0.27)、5年主要并发症发生率(RR=0.18,95% CI 0.1 1～0.30)均低于内固定术.但二者术后1个月和2年病死率差异均无统计学意义(RR=1.42,95%CI 0.89～2.24;RR=1.01,95%CI 0.86～1.18).结论 与内固定术相比,关节置换术治疗老年人移位型股骨颈骨折可明显降低术后主要并发症的发生率及再次手术率,但两种术式的术后2年病死率无明显差异.     

A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures

Background

Total hip arthroplasty or hemiarthroplasty are used to treat displaced femoral neck fractures. However, the optimal treatment of these fractures remained controversial.

Objective

To assess the effects that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fractures in the elderly.

Methods

We searched MEDLINE (January 1980 to 2010), EMBASE (January 1980 to 2010), and the Cochrane Library 2010; issue 1. Only prospective randomized controlled trials (RCTs) that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fracture in the elderly were included. The analysis was performed with software RevMan5.0 from the Cochrane Collaboration.

Results

We identified seven relevant randomized controlled trials with a total of 828 participants. The meta-analysis showed relative risk of re-operation was 0.40 (95% CI?=?0.24–0.67, P?=?0.0004), the dislocation was 2.02 (95% CI?=?1.26–3.25, P?=?0.002), the mobility as functional outcome was 1.70 (95% CI?=?1.21–2.38, P?=?0.002). It was reported that the average operating room times and blood loss volumes in total hip arthroplasty were more than in hemiarthroplasty (P?Conclusions Total hip arthroplasty is associated with better functional outcome and lower reoperation rate than hemiarthroplasty in treatment of displaced femoral neck fractures in the elderly patients.     

Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis

Purpose: By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event. Methods: The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: “total hip arthroplasty”, “hemiarthroplasty” and “femoral neck fracture” to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’ stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event. Results: This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up. Conclusion: Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.     

Intracapsular hip fractures in end-stage renal failure

Patients with end-stage renal failure (ESRF) have metabolic bone disease. This increases the risk of femoral neck fracture and increases the risk of complications associated with fracture fixation such as non-union and avascular necrosis (AVN). We report the results of treatment in a consecutive series of 15 intracapsular fractures of the hip occurring in 13 patients with ESRF over a 5-year period. Six intracapsular hip fractures (of which five were undisplaced) were treated by internal fixation. Five out of these six (mean=83.3%) required conversion to total hip arthroplasty because of non-union or AVN. In all six of these patients, internal fixation was considered adequate post operatively. Of the remaining nine intracapsular hip fractures treated by hemiarthroplasty, only one required conversion to total hip arthroplasty because of stem subsidence (mean=11%). The difference in the revision rate for the two groups i.e. primary fixation versus primary hemiarthroplasty was statistically significant (p-value=0.01). The six patients with undisplaced intracapsular fractures treated by internal fixation required a total of 14 major operations, at an average rate (including initial fracture fixation and revision surgery) of 2.3 per patient. The 9 displaced fractures treated by hemiarthroplasty required just 10 operations in total, at an average rate of 1.1 per patient. (The difference was significant; p-value=0.006.) The 1-year mortality in the whole group (13 patients with 15 fractures) was 44.4%. We suggest that patients with ESRF with an intracapsular fracture of the neck of femur should be treated by replacement arthroplasty irrespective of femoral head displacement because of the high risk of revision surgery associated with internal fixation.     

Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial

BACKGROUND: Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. METHODS: In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total hip arthroplasty or a hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford hip score, and final radiographs were assessed. RESULTS: After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23 mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group. Patients in the total hip arthroplasty group walked farther (p=0.039) and had a lower (better) Oxford hip score (p=0.033) than those in the hemiarthroplasty group. Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the hips in the hemiarthroplasty group dislocated, whereas three hips in the total hip arthroplasty group dislocated. In the hemiarthroplasty group, two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision. In the total hip arthroplasty group, one hip was revised because of subsidence of the femoral component. CONCLUSIONS: Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.     

Conversion of failed hip hemiarthroplasties after femoral neck fractures

Hemiarthroplasty has been the preferred treatment for fractures of the femoral neck in elderly patients. The objective of the current study was to assess the outcome of revision of failed hemiarthroplasty to total hip arthroplasty in patients with a primary diagnosis of a femoral neck fracture. One hundred thirty-two conversions were done in 108 women and 24 men. One hundred two cemented and 30 uncemented hemiprostheses were revised to 88 cemented, 17 uncemented, and 27 hybrid total hip arthroplasties and the patients were followed up an average of 7.1 years (range, 5.1-15.3 years). Nine hips (6.8%) were revised for loosening and four additional hips (3%) were loose at the last followup. Survivorship free of revision was 96.5% (95% confidence interval, 93%-100%) at 5 years and 92% (95% confidence interval, 86%-98%) at 10 years. Major perioperative complications occurred frequently (45%), including 12 intraoperative femoral fractures (9%) and 13 dislocations (9.8%) Three of 12 (25%) of the intraoperative femoral fractures developed later femoral component loosening and all occurred during conversion of an uncemented Austin-Moore type hemiprosthesis. Conversion of endoprostheses to total hip arthroplasties after femoral neck fractures is fraught with high complication and loosening rates. Careful patient selection for each type of arthroplasty (hemiarthroplasty versus total hip arthroplasty) may help ameliorate the outcome of arthroplasty for patients with femoral neck fractures.     

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fractures in patients over 70 years old

Objective:Total hip arthroplasty (THA)and hemiarthroplasty (HA) are effective methods currendy used to treat femoral neck fracture in elderly patients,but the two options remain controversial in patien...     

双侧髋关节同期与分期置换临床疗效与安全性的Meta分析

[目的]通过Meta分析方法在较大样本量的前提下,比较双侧髋关节同期与分期置换临床疗效与安全性.[方法] 按Cochrane系统评价方法,计算机检索Cochrane图书馆;MEDLINE( 1966 ～2011);Embase (1966 ～2011);中文期刊全文数据库(1979 ～2011);中国生物医学文献数据库(1979 ～2011);万方数据库和维普数据库.收集所有比较双侧髋关节同期与分期置换术后临床观察的随机对照试验,并评价纳入研究的方法学质量.采用Meta分析方法对手术时间、术中失血量、并发症率、翻修率及病死率等进行分析.统计软件采用Cochrane协作网提供的RevMan 4.2.8.[结果]纳入11个前瞻性随机对照研究,共2011例患者.Meta分析显示:(1)同期置换术后关节翻修率高于分期组[RR =2.11,P=0.03];两组术后3个月内病死率无显著性差异[RR=2.37,P=0.14];(2)同期置换手术及住院时间均较分期组短[P ＜0.001,P＜0.000 01];两组术中失血量比较无显著性差异[P=0.94];(3)同期置换术后局部血肿、感染[RR =2.72,P=0.002]及关节脱位[RR =2.41,P＜0.03]的发生率较分期组高;在术后深静脉血栓[ RR=0.66,P=0.45]、肺栓塞[RR=1.58,P=0.30]、心血管事件[RR=1.19,P=0.59]发生率发面,二者无统计学差异.[结论]现有临床资料显示,双侧髋关节同期置换较分期置换术后局部并发症风险增加.但由于研究质量和样本的局限性,上述结论有待设计严谨的大样本随机对照试验加以验证.因此,临床工作中对于治疗方法的选择应该谨慎.