关节置换术治疗老年无移位股骨颈骨折合理性Meta分析

doi:10.3969/j.issn.1009-976X.2020.06.017

摘要/Abstract

摘要： 目的比较无移位的老年股骨颈骨折内固定与关节置换术的疗效。方法以“Internal Fixation”、“Arthroplasty”、“Nondisplaced Femoral Neck Fractures”、“Elderly”为英文检索词,以“关节置换术”、“无移位股骨颈骨折”、“内固定”、“老年”为中文检索词,检索了MEDLINE、Ovid和中国知网数据库、万方数据库。入组标准为70岁以上;Garden Ⅰ或Ⅱ股骨颈骨折;螺钉内固定与关节置换术比较的研究。主要结果是再手术率。次要结果包括死亡率、术后并发症、髋关节Harris评分。由两位研究人员从纳入的研究中独立提取数据。应用STATA软件进行统计量合并。结果在901篇筛选的文章中,5篇文献符合入选标准,共有28591名患者（14296名接受关节置换术,14295名接受内固定治疗）。内固定组再手术率高于关节置换组（OR：0.02,95%CI：0.43~0.84）,差异具有统计学意义（Z=3.46,P=0.00）。两个治疗组之间的一年死亡风险、并发症及Harris评分没有显著差异。结论对于无移位的老年股骨颈骨折,关节置换术可降低再手术率,优于内固定治疗。对老年无移位股骨颈骨折行一期关节置换术具有合理性。

关键词: 关节置换术, 无移位股骨颈骨折, 老年, 内固定

Abstract: Objective To compare the effect of internal fixation and arthroplasty for senile femoral neck fracture without displacement. Methods The MEDLINE, Ovid and China KnowledgeNet database were searched,entry criteria were over 70 years of age; garden I or II femoral neck fracture and study comparing screw internal fixation with arthroplasty. The main result is the reoperation rate. Secondary outcomes included mortality, postoperative complications, and hip Harris score. Data was independently extracted from included studies by two researchers. Stata MP16 software was used for Statistical analysis. Results Of the 901 selected articles, 5 literatures met the selection criteria, with a total of 28,591 patients （14,296 receiving arthroplasty and 14,295 receiving internal fixation）. The reoperation rate in the internal fixation group was higher than that in the joint replacement group （OR：0.02,95% CI：0.43~0.84）, and the difference was statistically significant （Z=3.46, P=0.00）. There was no significant difference in one-year mortality risk, complications and Harris scores between the two treatment groups. Conclusion For the senile femoral neck fracture without displacement, arthroplasty can reduce the reoperation rate, which is better than internal fixation. It is reasonable to perform the first stage arthroplasty for the elderly with undisplaced femoral neck fracture.

Key words: undisplaced femoral neck fracture, senile, arthroplasty, internal fixation

中图分类号:

R681.5

李洪彬, 刘楠. 关节置换术治疗老年无移位股骨颈骨折合理性Meta分析[J]. 岭南现代临床外科, 2020, 20(06): 766-770.

LI Hong-bin, LIU Nan. Meta-analysis of the rationality of arthroplasty in the treatment of undisplaced femoral neck fracture[J]. Lingnan Modern Clinics in Surgery, 2020, 20(06): 766-770.

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