骨水泥型与非骨水泥型半髋关节置换治疗老年移位型股骨颈骨折疗效的Meta分析
摘要
目的系统性评价骨水泥型与非骨水泥型半髋关节置换治疗老年移位型股骨颈骨折的疗效及对术中出血和并发症的影响。方法计算机检索外文数据库Pubmed、Embase、Cochrane Library、Web of science,中文数据库中国知网、万方和维普及中国生物医学文献数据库,检索时间为从建库至2018年2月,检索骨水泥型与非骨水泥型半髋关节置换治疗老年移位型股骨颈骨折的随机对照试验(RCT)。比较两组患者手术时间、术中出血量、住院时间、术后并发症、术后病死率,应用RevMan 5.3统计学软件进行分析。结果共纳入16篇RCTs,共2 384例半髋关节置换患者。结果显示:骨水泥组手术时间长[OR=7.94,95%CI(5.69～10.02),P<0.000 01],肺栓塞发生率高[OR=3.95,95%CI(0.97～16.02),P=0.05],但术中及术后假体周围骨折发生率低[OR=0.25,95%CI(0.13～0.47),P<0.000 1],住院时间短[WMD=-1.78,95%CI(-3.38～-0.17),P=0.03]。病死率、下肢深静脉血栓形成率、关节脱位率、术中失血量及术后肺部、泌尿系、切口感染的发生率两组之间无统计学差异。结论与非骨水泥组相比,骨水泥组手术时间长、肺栓塞发生率高,但在术中及术后假体周围骨折和住院时间上有优势,且并未增加病死率、下肢深静脉血栓形成率、关节脱位率、术中失血量及术后肺部、泌尿系、切口感染的发生率。
引文
1 李建国.生物型与骨水泥型人工半髋关节假体治疗老年股骨颈骨折的效果及并发症比较[J].中国综合临床,2017;33(12):1127-30.
2 魏志辉,赵波,何超,等.骨水泥与非骨水泥半髋关节置换治疗老年股骨颈骨折的Meta分析[J].中国矫形外科杂志,2016;24(14):1287-94.
3 Ning GZ,Li YL,Wu Q,et al.Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures:an updated meta-analysis[J].Eur J Orthop Surg Traumatol,2014;24(1):7-14.
4 Inngul C,Blomfeldt R,Ponzer S,et al.Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck:a randomised controlled trial[J].Bone Joint J,2015;97-B(11):1475.
5 Khorami M,Arti H,Aghdam AA.Cemented versus uncemented hemiarthroplasty in patients with displaced femoral neck fractures[J].Pak J Med Sci,2016;32(1):44-8.
6 Moerman S,Mathijssen NMC,Niesten DD,et al.More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures:a randomized controlled trial of 201 patients,with one year follow-up[J].BMC Musculoskelet Disord,2017;18(1):300.
7 Taylor F,Wright M,Zhu M.Hemiarthroplasty of the hip with and without cement:a randomized clinical trial[J].J Bone Joint Surg Am,2012;94(7):577-83.
8 杜正根.骨水泥和非骨水泥型人工双动股骨头置换疗效分析[J].中国医学工程,2014;11(1):29-30.
9 马川,江锋,黄陈翼,等.骨水泥型与生物型假体髋关节置换术治疗老年股骨颈骨折疗效研究[J].检验医学与临床,2016;13(13):1826-8.
10 Parker MI,Pryor G,Gurusamy K.Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures:a randomised controlled trial in 400 patients[J].J Bone Joint Surg Br,2010;92(1):116.
11 Emery RJ,Broughton NS,Desai K,et al.Bipolar hemiarthroplasty for subcapital fracture of the femoral neck.A prospective randomised trial of cemented thompson and uncemented moore stems[J].J Bone Joint Surg Br,1991;73(2):322-4.
12 Langslet E,Frihagen F,Opland V,et al.Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures:5-year followup of a randomized trial[J].Clin Orthop Relat Res,2014;472(4):1291-9.
13 潘沈淇.骨水泥型和非骨水泥型半髋关节置换术治疗移位股骨颈骨折的疗效比较[J].中国医师进修杂志,2013;36(17):41-3.
14 Talsnes O,Hjelmstedt F,Pripp AH,et al.No difference in mortality between cemented and uncementedhemiprosthesis for elderly patients with cervical hip fracture.A prospective randomized study on 334 patients over 75 years[J].Arch Orthop Trauma Surg,2013;133(6):805-9.
15 Deangelis JP,Ademi A,Staff I,et al.Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures:a prospective randomized trial with early follow-up[J].J Orthop Trauma,2012;26(3):135-40.
16 Vidovic D,Punda M,Darabos N,et al.Regional bone loss following femoral neck fracture:A comparison between cemented and cementlesshemiarthroplasty[J].Injury,2015;46(Suppl 6):S52-6.
17 Sonne-holm S,Dyrbye M,Walter S,et al.Bone scintigraphy in moore hemiarthroplasty with and without cement following femoral neck fractures.A controlled study[J].Acta Orthop Scand,1983;54(2):194-7.
18 Rogmark C,Leonardsson O.Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients[J].Bone Joint J,2016;98-B(3):291.
19 Grosso MG,Danoff JR,Padgett DE,et al.The cemented unipolar prosthesis for the management of displaced femoral neck fractures in the dependent osteopenic elderly[J].J Arthroplasty,2015;31(5):1040-6.
20 贾金领,侯文根,张君,等.髋关节置换术后发生脱位的危险因素分析[J].中国矫形外科杂志,2016;24(17):1624-7.
21 Borghi B,Casati A.Thromboembolic complications after total hip replacement[J].Int Orthop,2002;26(1):44-7.
22 王雨,王爱民.与骨水泥相关的肺栓塞[J].中国矫形外科杂志,2005;13(8):615-6.
2 魏志辉,赵波,何超,等.骨水泥与非骨水泥半髋关节置换治疗老年股骨颈骨折的Meta分析[J].中国矫形外科杂志,2016;24(14):1287-94.
3 Ning GZ,Li YL,Wu Q,et al.Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures:an updated meta-analysis[J].Eur J Orthop Surg Traumatol,2014;24(1):7-14.
4 Inngul C,Blomfeldt R,Ponzer S,et al.Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck:a randomised controlled trial[J].Bone Joint J,2015;97-B(11):1475.
5 Khorami M,Arti H,Aghdam AA.Cemented versus uncemented hemiarthroplasty in patients with displaced femoral neck fractures[J].Pak J Med Sci,2016;32(1):44-8.
6 Moerman S,Mathijssen NMC,Niesten DD,et al.More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures:a randomized controlled trial of 201 patients,with one year follow-up[J].BMC Musculoskelet Disord,2017;18(1):300.
7 Taylor F,Wright M,Zhu M.Hemiarthroplasty of the hip with and without cement:a randomized clinical trial[J].J Bone Joint Surg Am,2012;94(7):577-83.
8 杜正根.骨水泥和非骨水泥型人工双动股骨头置换疗效分析[J].中国医学工程,2014;11(1):29-30.
9 马川,江锋,黄陈翼,等.骨水泥型与生物型假体髋关节置换术治疗老年股骨颈骨折疗效研究[J].检验医学与临床,2016;13(13):1826-8.
10 Parker MI,Pryor G,Gurusamy K.Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures:a randomised controlled trial in 400 patients[J].J Bone Joint Surg Br,2010;92(1):116.
11 Emery RJ,Broughton NS,Desai K,et al.Bipolar hemiarthroplasty for subcapital fracture of the femoral neck.A prospective randomised trial of cemented thompson and uncemented moore stems[J].J Bone Joint Surg Br,1991;73(2):322-4.
12 Langslet E,Frihagen F,Opland V,et al.Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures:5-year followup of a randomized trial[J].Clin Orthop Relat Res,2014;472(4):1291-9.
13 潘沈淇.骨水泥型和非骨水泥型半髋关节置换术治疗移位股骨颈骨折的疗效比较[J].中国医师进修杂志,2013;36(17):41-3.
14 Talsnes O,Hjelmstedt F,Pripp AH,et al.No difference in mortality between cemented and uncementedhemiprosthesis for elderly patients with cervical hip fracture.A prospective randomized study on 334 patients over 75 years[J].Arch Orthop Trauma Surg,2013;133(6):805-9.
15 Deangelis JP,Ademi A,Staff I,et al.Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures:a prospective randomized trial with early follow-up[J].J Orthop Trauma,2012;26(3):135-40.
16 Vidovic D,Punda M,Darabos N,et al.Regional bone loss following femoral neck fracture:A comparison between cemented and cementlesshemiarthroplasty[J].Injury,2015;46(Suppl 6):S52-6.
17 Sonne-holm S,Dyrbye M,Walter S,et al.Bone scintigraphy in moore hemiarthroplasty with and without cement following femoral neck fractures.A controlled study[J].Acta Orthop Scand,1983;54(2):194-7.
18 Rogmark C,Leonardsson O.Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients[J].Bone Joint J,2016;98-B(3):291.
19 Grosso MG,Danoff JR,Padgett DE,et al.The cemented unipolar prosthesis for the management of displaced femoral neck fractures in the dependent osteopenic elderly[J].J Arthroplasty,2015;31(5):1040-6.
20 贾金领,侯文根,张君,等.髋关节置换术后发生脱位的危险因素分析[J].中国矫形外科杂志,2016;24(17):1624-7.
21 Borghi B,Casati A.Thromboembolic complications after total hip replacement[J].Int Orthop,2002;26(1):44-7.
22 王雨,王爱民.与骨水泥相关的肺栓塞[J].中国矫形外科杂志,2005;13(8):615-6.