全髋与半髋关节置换治疗老年股骨颈骨折的Meta分析

背景：目前全髋关节置换和半髋关节置换是治疗老年移位股骨颈骨折的有效方法，但两种方案的选择在临床治疗仍存争议。目的：对全髋关节置换与半髋关节置换治疗老年股骨颈骨折的疗效进行系统评价。方法：计算机检索Cochrane协作网数据库(2009年第1期)、MEDLINE(1966-01/2009-05)、EMbase(1984-01/2009-05)、中国生物医学文献数据库(CBM，1979-01/2009-05)、中文期刊全文数据库(1979-01/2009-05)。收集所有相关随机对照试验及半随机对照试验，并评价纳入研究的方法学质量。统计软件用Cochrane协作网提供的RevMan5.0.18。结果与结论：共纳入7个随机对照临床试验，包括648例患者。Meta分析结果显示，全髋与半髋关节置换的病死率、感染率差异均无显著性意义；全髋关节置换术中出血量多、手术时间长(P < 0.001)；远期随访全髋置换翻修率低于半髋置换(RR=0.28，95%CI=0.12~0.66，P=0.003)；全髋置换后脱位发生率高于半髋置换(RR=3.45，95%CI=1.29~9.19，P=0.01)；全髋置换后疼痛发生率低于少于半髋置换(RR=0.12，95%CI=0.05~0.30，P < 0.000 01)；全髋置换活动功能优于半髋置换(RR=1.32，95%CI=1.04~1.68，P=0.02)。提示短期随访全髋置换与半髋置换后病死率、翻修率、关节功能、脱位率、疼痛及感染率无明显差异；中期随访全髋置换的脱位发生率高于半髋置换；远期随访全髋置换后活动功能优于半髋置换，且翻修率和疼痛发生率明显低于半髋置换。

Meta analysis of total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in elderly patients

BACKGROUND: Total hip arthroplasty (THA) and hemiarthroplasty (HA) are effective therapies for displaced femoral neck fractures in eldery patients, but the choice of two procedures in the clinical treatment remains controversial.OBJECTIVE: To assess the effects of THA versus HA for optimal treatment of femoral neck fracture in the elderly.METHODS: A computer-based online search of Cochrane central register of controlled trials (first book in 2009), Medline (1966-01/2009-05), EMbase (1984-01/2009-05) and CBM (1979-01/2009-05), CNKI (1979-01/2009-05). Only RCTs that comparing THA with HA in treatment of femoral neck fracture in the elderly were included in a meta-analysis regarding mortality, reoperations and complications. The analysis was performed with software RevMan5.0.18 from the Cochrane collaboration.RESULTS AND CONCLUSION: A total of 7 RCTs with a total of 648 participants were included. The meta-analysis showed the mortality and postoperative infection rates between THA and HA groups were not significantly different; the average operating room time and blood loss volumes in the THA group were greater than the HA group (P < 0.001). Revision in long-term follow up in the THA group were lower than the HA group (RR = 0.28, 95%CI = 0.12-0.66, P = 0.003). The dislocation in medium-term follow-up in the THA group were greater than the HA group (RR=3.45, 95%CI =1.29-9.19, P = 0.01). The rate of the pain in long-term follow-up in the THA group were lower than the HA group (RR = 0.12, 95%CI = 0.05-0.30, P < 0.000 01). The mobility in the THA group was better than the HA group (RR = 1.32, 95%CI = 1.04-1.68, P = 0.02). Results suggest that, in short-term follow up there was no difference in mortality, reoperation, dislocation, pain, mobility, wound infection rates between the THA and the HA groups; the dislocation occurred in the THA group more frequently than the HA group in medium-term follow up; while, the revision and pain occurrance in the THA group were less than the HA group, and the mobility of the THA group was more superior than the HA group in long-term follow up.