中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (35): 6483-6496.doi: 10.3969/j.issn.1673-8225.2010.35.006

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

全髋关节置换与人工股骨头置换治疗高龄患者股骨颈骨折有效性与安全性的Meta分析

陈广栋1，王振斌2，陈建常3，路兰鸿4，李秀清5，汪惠才6   

  1. 1新疆医科大学，新疆维吾尔自治区乌鲁木齐市 830011；2新疆医科大学第四附属医院脊柱一科，疆维吾尔自治区乌鲁木齐市830000；3解放军兰州军区乌鲁木齐总医院全军骨科中心，疆维吾尔自治区乌鲁木齐市  830000；4沧州医学高等专科学校，河北省沧州市  061001；5沧州市人民医院，河北省沧州市061001；6 新疆医科大学一附院循证医学教研室，新疆维吾尔自治区乌鲁木齐市 830011
  • 出版日期:2010-08-27 发布日期:2010-08-27
  • 通讯作者: 王振斌，硕士，副主任医师，新疆医科大学第四附属医院脊柱一科，新疆维吾尔自治区乌鲁木齐市 830000 wangzb0202@163.com
  • 作者简介:陈广栋★，男，1983年生，河北省沧州市人，汉族 ，新疆医科大学在读硕士，主要从事脊柱外科及骨组织工程方面的研究。 victordongdong@sina.com

Total hip replacement versus femoral head replacement in treatment of elderly femoral neck fracture: Meta analysis of efficacy and safety

Chen Guang-dong1, Wang Zhen-bin2, Chen Jian-chang3, Lu Lan-hong4, Li Xiu-qing5, Wang Hui-cai6   

  1. 1 Xinjiang Medical University, Urumchi  830011, Xinjiang Uygur Autonomous Region, China; 2 First Department of Spinal Surgery, Fourth Affiliated Hospital of Xinjiang Medical University, Urumchi  830000, Xinjiang Uygur Autonomous Region, China; 3 Orthopedics Center of Urumchi General Hospital, Lanzhou Military Area Command of Chinese PLA, Urumchi  830000, Xinjiang Uygur Autonomous Region, China; 4 Cangzhou Medical College, Cangzhou  061001, Hebei Province, China; 5 Cangzhou People’s Hospital, Cangzhou  061001, Hebei Province, China; 6 Teaching and Research Section of Evidence-based Medicine, First Hospital of Xinjiang Medical University, Urumchi  830011, Xinjiang Uygur Autonomous Region, China
  • Online:2010-08-27 Published:2010-08-27
  • Contact: Wang Zhen-bin, Master, Associate chief physician, First Department of Spinal Surgery, Fourth Affiliated Hospital of Xinjiang Medical University, Urumchi 830000, Xinjiang Uygur Autonomous Region, China wangzb0202@163.com
  • About author:Chen Guang-dong★, Studying for master’s degree, Xinjiang Medical University, Urumchi 830011, Xinjiang Uygur Autonomous Region, China victordongdong@sina.com

PDF

439

被引次数

111

摘要：

目的：通过Meta分析方法在较大样本量的前提下，比较国内全髋关节置换与人工股骨头置换治疗高龄患者股骨颈骨折的临床疗效和安全性。
方法：计算机检索中国生物医学文献数据库CBM (2010-04)、中国期刊全文数据库CNKI (2010-04)、维普中文科技期刊数据库VIP (2010-04)及所有关于全髋关节置换与人工股骨头置换治疗高龄患者股骨颈骨折临床随机对照试验。采用Meta分析方法对假体关节功能、手术时间、术中出血量、出现并发症、髋关节残余疼痛进行综合分析。
结果：纳入7个临床对照研究，共624例高龄患者(>60岁)。其中行全髋关节置换实验组329例，人工股骨头置换对照组295例。Meta分析发现：①全髋关节置换组在疗效上优于人工股骨头置换组[OR=2.88和95%可信区间为(1.84, 4.49)，P < 0.05]。②实验组手术时间上长于对照组[WMD=43.35和95%可信区间为(23.96，62.74)，P < 0.05]。③实验组术中出血量多于对照组[WMD=336.36和95%可信区间为(196.34，476.37)，P < 0.05]。④两组术后出现并发症无明显统计学差异[OR=0.54和95%可信区间为(0.29，1.02)，P > 0.05]。⑤实验组髋关节残余痛少于对照组[OR=0.30和95%可信区间为(0.18， 0.50)，P < 0.05]。
结论：全髋关节置换治疗高龄股骨颈骨折较人工股骨头置换具有更好的远期临床效果，尤其适用于原发髋关节疾病和较强活动能力者。但全髋关节置换手术持续时间与术中出血量明显高于人工股骨头置换，因此在临床工作中对于治疗方法的选择应该谨慎。由于纳入研究数量少且质量不高，论证强度较弱，尚需开展和设计大样本随机对照研究做进一步验证。 

关键词: 股骨颈骨折, 全髋关节置换, 人工股骨头置换, Meta分析, 人工假体

Abstract:

OBJECTIVE: To compare the clinical outcomes and safety between total hip replacement and femoral head replacement in treatment of elderly patients with femoral neck fracture based on Meat analysis of large samples.
METHODS: A computer-based online search of CBM (2010-04), CNKI (2010-04) and VIP (2010-04) was performed for clinical randomized trials regarding total hip replacement and femoral head replacement in treatment of elderly patients with femoral neck fracture. Meta analysis was used to analyze prosthesis function, operation time, bleeding, complication and hip pain.
RESULTS: A total of 7 clinical control studies were included, involving 624 patients aged > 60 years, including 329 patients undergoing total hip replacement (experimental group) and 295 undergoing femoral head replacement (control group). Meta analysis showed that the efficacy of total hip replacement was better than femoral head replacement [OR=2.88, 95% confidence interval (1.84, 4.49), P < 0.05]. The operation time of experimental group was longer than control group [WMD=43.35, 95% confidence interval (23.96, 62.74), P < 0.05]. The bleeding volume of experimental group was greater than control group [WMD=336.36, 95% confidence interval (196.34, 476.37), P < 0.05]. There were no significant differences in complications between two groups [OR=0.54, 95% confidence interval (0.29, 1.02), P > 0.05]. The hip joint pain of experimental group was less than control group [OR=0.30, 95% confidence interval (0.18, 0.50), P < 0.05].
CONCLUSION: Total hip replacement exhibited better long-term clinical outcomes compared with femoral head replacement in treatment of elderly femoral head fracture, in particular for primary hip disease and for patients with strong activity. However, the operation time and bleeding volume were greater than femoral head replacement. Large sample, randomized, controlled studies are required for further validation.

中图分类号: