Hip arthroplasty and internal fixation for the repair of femoral neck fracture in the elderly patients: a meta-analysis of reoperation and complications

doi:10.3969/j.issn.2095-4344.2014.31.021

Abstract

Abstract:

BACKGROUND: Hip arthroplasty and internal fixation are presently effective therapeutic methods in treatment of femoral neck fracture in the elderly. However, which method can reduce the incidence of postoperative complications remains controversial.
OBJECTIVE: To systematically review the reoperation, postoperative complications and 1-year and 2-year mortality after hip arthroplasty and internal fixation in the elderly with femoral neck fracture.
METHODS: Pubmed/Medline, EMBASE, and Cochrane CENTRAL databases were retrieved by computer for articles published before May 2013. Systematic review on randomized controlled trials of hip arthroplasty versus internal fixation for femoral neck fractures in the elderly was conducted using the Cochrane Collaboration’s RevMan 5.2 software. Outcome measures included reoperation, main complications related to the surgery and mortality.
RESULTS AND CONCLUSION: Six published randomized controlled trials of nine literatures containing 1 496 cases were involved in this review. Meta-analysis results indicated that reoperation rate was greater in the internal fixation group within and more than 2 years after the surgery compared with the hip arthroplasty group (P < 0.000 01). Compared with hip arthroplasty group, internal fixation significantly increased the main complications related to the surgery [OR=8.79, 95%CI(6.50-11.88), P < 0.000 01]. No significant difference in 1-year and 2-year mortality after surgery was detected between the internal fixation and hip arthroplasty groups [OR=0.85, 95%CI(0.66-1.11), P=0.23; OR=0.88, 95%CI(0.70-1.10), P=0.27]. These data suggested that the
long-term reoperation rate and incidence of main complications were obviously higher in internal fixation compared with hip arthroplasty for femoral neck fracture in the elderly, and no significant difference in 1-year and 2-year mortality after the surgery was detectable between the two methods. Clinical recommended hip arthroplasty in the repair of femoral neck fracture in the elderly.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: femoral neck fractures, arthroplasty, replacement, hip, internal fixators, meta-analysis

CLC Number:

R318

Ji Ning, Sun Zhen-hui, Jiang Ze-hua, Zhang Yu, Wang Lei, Zhang Xue-li. Hip arthroplasty and internal fixation for the repair of femoral neck fracture in the elderly patients: a meta-analysis of reoperation and complications[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(31): 5044-5049.

Figures/Tables 2

2.1 文献检索结果经全面计算机及手工检索，共检索到356篇临床试验文献：PubMed检索获得文献36篇，Embase检索获得文献275篇，Cochrane CENTRAL检索获得文献48篇。共有9篇随机对照试验研究文献合格[7-15]，合并同一组患者不同随访时间发表的3篇文章，最终共有6个随机对照试验研究被纳入，均为英文文献。样本总量合计1 496例。各纳入研究的基本情况见表1。纳入研究的6个随机对照试验中患者的年龄、性别比基本资料经统计学检验在基线水平上一致。6个随机对照试验文献质量等级均为低风险。 2.2 Meta分析结果 2.2.1 再手术情况比较含有内固定取出手术比较：共3个随机对照试验报道了术后2年内再手术情况，内固定组198例，髋关节置换组38例，发生率分别为51.8%和10.8%，各研究间无统计学异质性(P=0.50，I2=0%)，固定效应Meta分析表明与髋关节置换相比，内固定显著增加了再手术 [OR=9.00，95% CI(6.07-13.34)，P < 0.000 01]。术后2年以上再手术情况(共5个随机对照试验报道)，内固定组342例，髋关节置换组62例，发生率分别为52.52%和9.95%，各研究间无统计学异质性(P=0.46，I2=0%)，固定效应Meta分析表明与髋关节置换相比，内固定显著增加了再手术[OR=10.25，95% CI(7.53-13.96)，P < 0.000 01]。两个亚组合并后共有8个随机对照试验报道，内固定组540例，髋关节置换组100例，发生率分别为52.3%和10.3%，各研究间无统计学异质性(P=0.65，I2=0%)，固定效应Meta分析表明与髋关节置换相比，内固定能够显著增加再手术风险[OR=9.76，95% CI(7.65-12.44)，P < 0.000 01]。Meta 分析结果稳定，倒漏斗图显示基本对称(图1)。不含有内固定取出手术比较：术后2年内再手术内固定组166例，髋关节置换组38例，发生率分别为43.5%和10.8%，各研究间无统计学异质性(P=0.21，I2=36%)，固定效应Meta分析表明与髋关节置换相比，内固定显著增加再手术[OR=6.42，95%CI(4.33-9.52)，P < 0.000 01]。术后2年以上再手术内固定组273例，髋关节置换组62例，发生率分别为41.9%和10.0%，各研究间无统计学异质性(P=0.24，I2=27%)，固定效应Meta分析表明与髋关节置换相比，内固定显著增加再手术[OR=6.59，95%CI (4.84-8.97)，P < 0.000 01]。两个亚组合并后内固定组再手术439例，髋关节置换组100例，发生率分别为42.5%和10.3%，各研究间无统计学异质性(P=0.29，I2=18%)，固定效应Meta分析表明与髋关节置换相比，内固定能够显著增加再手术[OR=6.53，95%CI(5.12-8.32)，P < 0.000 01]。Meta分析结果稳定，倒漏斗图显示基本对称(图2)。 2.2.2 手术相关主要并发症比较 6个随机对照试验均报道了股骨颈骨折术后手术相关主要并发症，内固定组335例，髋关节置换组63例，发生率分别为43.9%和8.6%，各研究间无统计学异质性(P=0.94，I2=0%)，故采用固定效应模型Meta分析。结果显示：老年股骨颈骨折与髋关节置换相比，内固定能够显著增加手术主要相关并发症[OR=8.79，95%CI (6.50-11.88)，P < 0.000 01]。Meta分析结果稳定，倒漏斗图显示基本对称(图3)。 2.2.3 股骨颈骨折术后死亡率比较 ①术后1年内死亡率：共4个随机对照试验报道了术后1年内死亡率，内固定组141例，髋关节置换组157例，发生率分别为21.5%和24.7%，各研究间无统计学异质性(P=0.98，I2=0%)，固定效应Meta分析表明老年股骨颈骨折髋关节置换和内固定相比，术后1年内死亡率差异无显著性意义[OR=0.85，95%CI(0.66-1.11)，P=0.23]。②术后2年内死亡率：6个随机对照试验均报道了术后2年内的死亡率，内固定组240例，髋关节置换组255例，发生率分别为31.5%和34.8%，各研究间无统计学异质性(P=0.45，I2=0%)，固定效应Meta分析表明老年股骨颈骨折髋关节置换和内固定相比，术后2年内死亡率差异无显著性意义[OR=0.88，95%CI (0.70-1.10)，P=0.27，见图4]。"

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