半髋关节置换与DHS内固定治疗高龄不稳定型转子间骨折Meta分析

目的对半髋关节置换与动力髋螺钉（DHS）内固定治疗高龄不稳定型转子间骨折术后疗效进行评价。方法按照Cochrane系统评价的方法，计算机检索下列数据库：Medline（1995／2012-05）、Pubmed（1995／2012-05）、SPINGER（1995／2012-05）、JohnWiley（1995／2012-05）、ScienceDirect（1995／2012-05）、EBSCO（1995／2012-05）、CNKI（1995／2012-05）、万方数数据库（1995／2012—05），并采用手工检索等方法收集会议文献。文献检索无语种限制。收集所有相关随机对照试验，采用Cochrane协作网提供的软件Revman4．2进行Meta分析。结果经过筛选，共纳入8个临床随机对照实验共548例患者。Meta分析结果显示两组患者半髋关节置换组比DHS组手术时间更长RR=-5．18，95％CI（-7．88，-2．48），P〈0．01]。两组患者术后内科并发症都有发生，DHS组较半髋关节置换组术后内科并发症发生率更高RR=2．66，95％CI（1．57，4．50），P〈0．01]。两组患者术后内植物相关并发症发生率有明显差异，DHS组发生率较半髋关节置换明显增高RR=5．09，95％CI（2．49，10．41），P〈0．01]。术后两组Harris评分都增高，半髋关节置换组增高明显RR=-8．19，95％CI（-9．45，-6．93），P〈0．01]。结论DHS内固定组较半髋关节置组换时间短，DHS内固定组术后内科并发症较半髋关节组发生率高，DHS内固定组术后内植物并发症较半髋关节组发生率高。术后Harris评分半髋关节置换组功能评分较DHS内固定组高。

Meta-analysis of curative effects comparison of hemiarthroplasty and dynamic hip screw for treatment of unstable intertrochanteric femoral fracture in elderly patients

Objective To observe the clinical efficacies of hemiarthroplasty and dynamic hip screw （DHS） in treatment of unstable intertrochanteric femoral fracture in the elderly. Methods In order to collecting controlled trials on DHS and hemiarthroplasty in treatment of intertrochanteric fractures, MEDLINE （ 1995 to May 2012）, Pubmed （ 1995 to Sep-May 2012）, SPRINGER （ 1995 to Sep- May 2012） , John Wiley （ 1995 to Sep- May 2012）, Science Direct （ 1995 to Sep- May 2012）, EBSCO （ 1995 to Sep- May 2012）, CNKI （1995 to Sep- May 2012） and WANFANG （1995 to Sep- May 2012） were searched by computer; manual search of related journals was also performed. The included studies were randomized controlled tests and data analysis was performed by the Cochrane Collaboration＇ s RevMan 4.2 software. Results Eight randomized controlled trials involving a total of 548 patients were included. The surgery time of control group decreased more significantly than the test group RR ： 2. 66, 95 % CI （ - 7.88, - 2.48） , P 〈 0. 01 ]. Meta analysis showed that the medical complications occurred in both groups, but the incidence of medical complications in the control group was significantly higher than that in the test group RR = 2. 66, 95% CI（ 1.57, 4. 50）, P 〈 0. 01 ]. The implant -related complications occurred in both groups, but the incidence of control group was significantly higher than that of the test group RR = 5.09,95%CI（2.49, 10.41 ）, P 〈 0.01 ]. The postoperative Harris scores increased in both groups, but it increased more in the test group than in the control group RR = - 8.19, 95% CI（ - 9.45, - 6. 93 ）, P 〈 0. 01 ]. Conclusion Compared with hemiarthroplasty, DHS may reduce the surgery time, but DHS has higher incidence of the medical and implant-related complications than hemiarthroplasty. The postoperative Harris scores of hemiarthroplasty increased more than that of DHS.