防旋型股骨近端髓内钉与全髋关节置换修复老年股骨转子间骨折的Meta分析
|
摘要
背景:目前临床上已经有大量针对防旋型股骨近端髓内钉与全髋关节置换修复老年股骨转子间骨折的临床疗效报道,但哪种修复方式更有优越性,目前尚无明确结论。目的:系统评价防旋型股骨近端髓内钉与全髋关节置换对老年股骨转子间骨折的修复效果。方法:通过计算机检索2011至2015年万方数据库、Pub Med、MEDLINE、Embase数据库等,同时手工检索国内主要期刊,搜集有关防旋型股骨近端髓内钉与全髋关节置换修复老年股骨转子间骨折的随机对照试验,选择术中出血量、手术时间、住院时间、术后下床行走时间、Harris评分作为评价指标,采用Rev Man 5.2进行数据分析。结果与结论:最终共纳入7篇文献,共811例患者,均为中文文献。Meta分析结果显示,全髋关节置换组住院时间及下床负重时间明显短于防旋型股骨近端髓内钉组(P<0.000 01),可减轻患者痛苦;全髋关节置换组在手术时间及术中出血方面,不如防旋型股骨近端髓内钉组效果好(P<0.000 01);且两者治疗后髋关节Harris评分差异无显著性意义(P>0.05)。提示防旋型股骨近端髓内钉置入内固定在微创治疗,即减少手术时间及术中出血方面有一定优势,全髋关节置换后可使患者较早恢复髋关节功能,允许早期负重行走,减少患者卧床时间,降低卧床并发症。因此临床应该根据老年股骨转子间骨折患者身体状况、损伤程度、骨折类型、经济承受能力等综合情况考虑选择合适的修复方案。
BACKGROUND: Now, the current study has not yet confirmed two treatment methods of the proximal femoral nail antirotation and total hip arthroplasty for treating intertrochanteric fractures in the elderly, which method has more advantages, and there is no clear conclusion at present. OBJECTIVE: To systematically compare the repair effect of proximal femoral nail antirotation and total hiparthroplasty for treatment of intertrochanteric fractures in the elderly. METHODS: We searched the related literatures from 2011 to 2015 on Wanfang database, Pub Med, MEDLINE and Embase database by computer. We retrieved the journals in China by hand and collected randomized controlled trials on proximal femoral nail antirotation and total hip arthroplasty in the treatment of intertrochanteric fractures in the elderly. Intraoperative blood loss, operation time, hospitalization time, ambulation time after operation, and Harris score were selected as evaluation indexes. Data were analyzed using Rev Man 5.2 software. RESULTS AND CONCLUSION: Finally, 7 Chinese literatures were included, with 811 patients. The results of meta analysis showed that the hospitalization time and ambulation time after operation were significantly shorter in the total hip arthroplasty group than in the proximal femoral nail antirotation group(P < 0.000 01), which reduced the pain of patients. Operation time and intraoperative blood loss were poorer in the total hip arthroplasty group than in the proximal femoral nail antirotation group(P < 0.000 01). No significant difference in Harris hip score was detected between the two groups(P > 0.05). These results confirmed that the internal fixation of proximal femoral nail antirotation in minimally invasive therapy when reducing operation time and blood loss has a certain advantage. The total hip arthroplasty can make the recovery of hip function earlier, allow early weight-bearing walking, reduce the patients' bedridden time and reduce the complications in bed. Thus, the clinicians in the practical work should choose the appropriate therapy with considering the patient's condition, damage degree, fracture type, and financial capability.
BACKGROUND: Now, the current study has not yet confirmed two treatment methods of the proximal femoral nail antirotation and total hip arthroplasty for treating intertrochanteric fractures in the elderly, which method has more advantages, and there is no clear conclusion at present. OBJECTIVE: To systematically compare the repair effect of proximal femoral nail antirotation and total hiparthroplasty for treatment of intertrochanteric fractures in the elderly. METHODS: We searched the related literatures from 2011 to 2015 on Wanfang database, Pub Med, MEDLINE and Embase database by computer. We retrieved the journals in China by hand and collected randomized controlled trials on proximal femoral nail antirotation and total hip arthroplasty in the treatment of intertrochanteric fractures in the elderly. Intraoperative blood loss, operation time, hospitalization time, ambulation time after operation, and Harris score were selected as evaluation indexes. Data were analyzed using Rev Man 5.2 software. RESULTS AND CONCLUSION: Finally, 7 Chinese literatures were included, with 811 patients. The results of meta analysis showed that the hospitalization time and ambulation time after operation were significantly shorter in the total hip arthroplasty group than in the proximal femoral nail antirotation group(P < 0.000 01), which reduced the pain of patients. Operation time and intraoperative blood loss were poorer in the total hip arthroplasty group than in the proximal femoral nail antirotation group(P < 0.000 01). No significant difference in Harris hip score was detected between the two groups(P > 0.05). These results confirmed that the internal fixation of proximal femoral nail antirotation in minimally invasive therapy when reducing operation time and blood loss has a certain advantage. The total hip arthroplasty can make the recovery of hip function earlier, allow early weight-bearing walking, reduce the patients' bedridden time and reduce the complications in bed. Thus, the clinicians in the practical work should choose the appropriate therapy with considering the patient's condition, damage degree, fracture type, and financial capability.
引文
[1]Sandowski C,lubbeke A,Saudan M,et al.Treatment of reverse obligue and transverse intertrochanteric fractures with use of an intramedul ary nail or a 95°screw-place,a prospectives,randomized study.J Bone Joint Surg(Am).2002;84-(A):372-381.
[2]Chirodian N.Arch B,Parker MJ.Sliding hip screw fixation of tro-chanteric hip fractures:outcome of 1024 procedures.Injury.2005;36(6):793-800.
[3]Kesmezacar H,Ayhan E,Unlu MC,et al.Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture.J Trauma.2010;68(1):153-158.
[4]Kakar S,little D,Einhorn TA.Can we improve fixation and outcomes in the treatment Of femoral neck fracture femoral neck fracture?The use of pharmaceuticals.J Orthop Trauma.2009;23(b):413-421.
[5]Kadakia A,Langkamar VG.Cancellous screw fixation of undisplaced femoral neck fracrures in over 70 years.Injury Extra.2007;38(4):146-147.
[6]Efstathopoals NE,Nikolaou VS,Lazarettors JT.Intrameduallary fixation of interochanterie hip fractures a comparison of two implant designs.Int Orthop.2007;31(1):71-76.
[7]Parker MJ,White A,Boyle A.Fixation versus hemiarthro plasty for undisplaced intracapsular hip fractures.Injury.2008;39(7):791-795.
[8]Whatling GM,Nokes LD.Literatures review of current techniques for the insertion of distal screws into intramedully locking nails.Injury.2006;37(2):109-119.
[9]Chang Q,Liu S,Guan C,et al.Bipolar hip artroplasty.JArthroplasty.2011;26(8):1455-1459.
[10]焦祥,关鹏飞,苏立新.PFNA治疗老年不稳定性股骨头粗隆间骨折的疗效分析[J].组织工程与重建外科杂志,2013,9(1):40-41.
[11]Dai Z,Li Y,Jiang D.Meta-analysis comparing arthroplasty with internal fixation for displaced femoral neck fracture in the elderty.J Surg Res.2011;165(1):68-74.
[12]Zielinski SM,Meeuwis MA,Heetveld MJ,et al.Adherence to a femoral neck fracture treatment guideline.Int Orthop.2013.
[13]伍旭辉.PFNA和THA治疗老年性股骨粗隆间骨折的临床观察[J].中国医药导报,2012,9(36):85-89.
[14]库瓦提?绕线,杜曼?吐鲁木.DHS、PFNA及人工髋关节置换不同植入物治疗老年人股骨粗隆间骨折的临床疗效[J].临床和实验医学杂志,2014,11(13):1815-1817.
[15]吴松,邹玮君.不稳定型股骨粗隆间骨折行髋关节置换治疗的效果观察[J].当代医学,2014,3(20):40-41.
[16]徐丽辉.股骨近端防旋髓内钉、动力髋螺钉及人工关节置换治疗高龄股骨粗隆间骨折的疗效对比[J],中国老年学杂志,2012,32(24):5596-5598.
[17]杨希亮.髋关节置换和股骨近端髓内钉治疗粗隆间骨折的临床研究[J].中国医学创新,2013,8(10):125-127.
[18]杨中锋.老年股骨粗隆间骨折的外科治疗及其临床疗效观察[J].医学综述,2015,2(21):757-759.
[19]魏任远,姜卓男.全髋关节置换与股骨近端髓内钉治疗高龄股骨粗隆间骨折的临床疗效对比研究[J].临床合理用药,2014,7(7):116-117.
[20]Alderson P,Green S,Higgins JPT,et al.Cochrane Reviews’Handbook4.2.1//the Cochrane Library.UK:John Wiley&Sons,Ltd,2004.
[21]Smith AM,Mardones RM,Sperling JW,et al.Early complications Of operatively treated proximal humeralfractures.J Shoulder Elbow Surg.2007;16:14-24.
[22]Pu JS,Liu L,Wang GL,et al.Results of the proximal femoral nail anti-rotation(PFNA)inelderly Chinese patients.Int Orthop.2009;33(5):1441-1444.
[23]Lee YK,Ha YC,Chang BK,et al.Cementless bipolar hemiarthroplasty using a hydroxyatite-coated long sterm for osteoorotic unstable interochanteric fractures.J Arthrpolasty.2011;26(4):626-632.
[24]Lee YK,Ha YC,Park C,et al.Trends of Surgical Treatment in Femoral Neck Fracture.A Nation wide Study Based on Claim Registy.J Arthroplasty.2013;28(10):1839-1841.
[2]Chirodian N.Arch B,Parker MJ.Sliding hip screw fixation of tro-chanteric hip fractures:outcome of 1024 procedures.Injury.2005;36(6):793-800.
[3]Kesmezacar H,Ayhan E,Unlu MC,et al.Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture.J Trauma.2010;68(1):153-158.
[4]Kakar S,little D,Einhorn TA.Can we improve fixation and outcomes in the treatment Of femoral neck fracture femoral neck fracture?The use of pharmaceuticals.J Orthop Trauma.2009;23(b):413-421.
[5]Kadakia A,Langkamar VG.Cancellous screw fixation of undisplaced femoral neck fracrures in over 70 years.Injury Extra.2007;38(4):146-147.
[6]Efstathopoals NE,Nikolaou VS,Lazarettors JT.Intrameduallary fixation of interochanterie hip fractures a comparison of two implant designs.Int Orthop.2007;31(1):71-76.
[7]Parker MJ,White A,Boyle A.Fixation versus hemiarthro plasty for undisplaced intracapsular hip fractures.Injury.2008;39(7):791-795.
[8]Whatling GM,Nokes LD.Literatures review of current techniques for the insertion of distal screws into intramedully locking nails.Injury.2006;37(2):109-119.
[9]Chang Q,Liu S,Guan C,et al.Bipolar hip artroplasty.JArthroplasty.2011;26(8):1455-1459.
[10]焦祥,关鹏飞,苏立新.PFNA治疗老年不稳定性股骨头粗隆间骨折的疗效分析[J].组织工程与重建外科杂志,2013,9(1):40-41.
[11]Dai Z,Li Y,Jiang D.Meta-analysis comparing arthroplasty with internal fixation for displaced femoral neck fracture in the elderty.J Surg Res.2011;165(1):68-74.
[12]Zielinski SM,Meeuwis MA,Heetveld MJ,et al.Adherence to a femoral neck fracture treatment guideline.Int Orthop.2013.
[13]伍旭辉.PFNA和THA治疗老年性股骨粗隆间骨折的临床观察[J].中国医药导报,2012,9(36):85-89.
[14]库瓦提?绕线,杜曼?吐鲁木.DHS、PFNA及人工髋关节置换不同植入物治疗老年人股骨粗隆间骨折的临床疗效[J].临床和实验医学杂志,2014,11(13):1815-1817.
[15]吴松,邹玮君.不稳定型股骨粗隆间骨折行髋关节置换治疗的效果观察[J].当代医学,2014,3(20):40-41.
[16]徐丽辉.股骨近端防旋髓内钉、动力髋螺钉及人工关节置换治疗高龄股骨粗隆间骨折的疗效对比[J],中国老年学杂志,2012,32(24):5596-5598.
[17]杨希亮.髋关节置换和股骨近端髓内钉治疗粗隆间骨折的临床研究[J].中国医学创新,2013,8(10):125-127.
[18]杨中锋.老年股骨粗隆间骨折的外科治疗及其临床疗效观察[J].医学综述,2015,2(21):757-759.
[19]魏任远,姜卓男.全髋关节置换与股骨近端髓内钉治疗高龄股骨粗隆间骨折的临床疗效对比研究[J].临床合理用药,2014,7(7):116-117.
[20]Alderson P,Green S,Higgins JPT,et al.Cochrane Reviews’Handbook4.2.1//the Cochrane Library.UK:John Wiley&Sons,Ltd,2004.
[21]Smith AM,Mardones RM,Sperling JW,et al.Early complications Of operatively treated proximal humeralfractures.J Shoulder Elbow Surg.2007;16:14-24.
[22]Pu JS,Liu L,Wang GL,et al.Results of the proximal femoral nail anti-rotation(PFNA)inelderly Chinese patients.Int Orthop.2009;33(5):1441-1444.
[23]Lee YK,Ha YC,Chang BK,et al.Cementless bipolar hemiarthroplasty using a hydroxyatite-coated long sterm for osteoorotic unstable interochanteric fractures.J Arthrpolasty.2011;26(4):626-632.
[24]Lee YK,Ha YC,Park C,et al.Trends of Surgical Treatment in Femoral Neck Fracture.A Nation wide Study Based on Claim Registy.J Arthroplasty.2013;28(10):1839-1841.