人工股骨头置换与动力髋螺钉置入内固定修复老年股骨转子间骨折的Meta分析

背景:人工股骨头置换相比动力髋螺钉内固定在治疗老年股骨转子间骨折上优势明显。目的:探讨老年人股骨转子间骨折使用人工股骨头置换与动力髋螺钉内固定的疗效,比较两种不同治疗选择的差异。方法:检索PubMed、Medline、CNKI、维普等数据库,收集老年股骨转子间骨折行人工股骨头置换与动力髋螺钉内固定的临床对照试验,提取基线资料、手术时间、术中出血量、住院时间、术后负重下床时间、并发症发生率、最后随访时的Harris评分和功能恢复优良率等数据,采用RevMan5.0.25进行Meta分析。结果与结论:纳入11个临床对照研究,共1227例患者,其中人工股骨头置换组587例,动力髋螺钉组640例。人工股骨头置换组与动力髋螺钉组比较,手术时间、术中出血量差异均无显著性意义,住院时间较短[RR=-2.56,95%CI(-3.27,-1.85),P<0.00001]、置入后负重下床时间较早[RR=-50.09,95%CI(-62.73,-37.45),P<0.00001]、并发症发生率较低[RR=0.39,95%CI(0.28,0.55),P<0.00001],最后随访时的Harris评分[RR=4.19,95%CI(3.04,5.34),P<0.00001]和功能恢复优良率[RR=2.25,95%CI(1.49,3.40),P=0.0001]均较高。与动力髋螺钉内固定相比,人工股骨头置换不明显增加手术时间和术中出血量,但显著缩短住院时间、置入后下床负重时间,降低置入后并发症发生率,提高Harris评分及功能恢复优良率,在治疗老年人股骨转子间骨折上具有明显的优势。

Artificial femoral head replacement versus dynamic hip screws in elderly intertrochanteric fracture: A meta analysis

BACKGROUND:Artificial femoral head replacement is superior to dynamic hip screws (DHS) in treating elderly intertrochanteric fracture.OBJECTIVE:To compare the clinical effects between artificial femoral head replacement and DHS in treating elderly intertrochanteric fracture.METHODS:The databases of PubMed,Medline,CNKI and VIP were searched online.All the trials comparing artificial femoral head replacement with dynamic hip screws in elderly intertrochanteric fracture were included.Data of baseline information,operation time,bleeding amounts,hospitalization time,weight-bearing time,complication rate,Harris score and the excellent rate were collected and meta-analyzed with RevMan5.0.25.RESULTS AND CONCLUSION:Eleven trials with 1 227 patients were included,including 587 artificial femoral head replacement and 640 DHS.The meta-analysis showed that there were no significant differences in operation time and bleeding amounts between the two groups.However,the hospitalization time was shorter [RR=-2.56,95%CI (-3.27,-1.85),P<0.000 01],the weight-bearing time was earlier [RR=-50.09,95%CI (-62.73,-37.45),P<0.000 01],the complication rate was lower [RR=0.39,95%CI (0.28,0.55),P<0.000 01],the Harris score was higher [RR=4.19,95%CI (3.04,5.34),P<0.000 01] and the excellent rate at final follow-up was higher [RR=2.25,95%CI (1.49,3.40),P=0.000 1] in the artificial femoral head replacement group.Results indicate that artificial femoral head replacement would not increase the operation time and bleeding amounts,but would shorten the hospitalization time and weight-bearing time,reduce the complication rate and improve the function.Artificial femoral head replacement is recommended in treating elderly intertrochanteric fracture due to its obvious superiority.