Parker M J, Handoll H H
Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA.
Cochrane Database Syst Rev. 2000(2):CD000086. doi: 10.1002/14651858.CD000086.
Internal fixation, commonly used for extracapsular hip fractures, may fail particularly in unstable fractures. Replacement of the hip using arthroplasty, often used for intracapsular fractures, has been used as an alternative.
To compare replacement arthroplasty with internal fixation for the treatment of extracapsular hip fractures in adults.
We searched the Cochrane Musculoskeletal Injuries Group's trials register and bibliographies of published papers, and contacted colleagues. Date of the most recent search: August 1999.
Randomised and quasi-randomised trials comparing replacement arthroplasty with an internal fixation implant for skeletally mature patients with an extracapsular hip fracture.
Both reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from trialists. Odds ratios and 99% confidence intervals were calculated for relevant dichotomous outcomes and presented graphically.
Only one randomised trial of 90 patients with unstable extracapsular hip femoral fractures in the trochanteric region was identified and included in this review. This compared arthroplasty with a sliding hip screw and was of poor methodological quality. From the limited data available for this trial, there were no significant differences between the two methods of treatment for operating time, local wound complications, mortality rate or mobility of previously independent patients. There was however a reportedly higher blood transfusion need in the arthroplasty group.
REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over the sliding hip screw for extracapsular hip fractures. Further well designed randomised trials for the treatment of these fractures for this comparison are required.
内固定常用于髋关节囊外骨折，尤其在不稳定骨折中可能会失败。髋关节置换术常用于髋关节囊内骨折，已被用作一种替代方法。
比较置换关节成形术与内固定术治疗成人髋关节囊外骨折的效果。
我们检索了Cochrane肌肉骨骼损伤组的试验注册库和已发表论文的参考文献，并联系了同行。最近一次检索日期为1999年8月。
比较置换关节成形术与内固定植入物治疗骨骼成熟的髋关节囊外骨折患者的随机和半随机试验。
两位评价者独立使用十项量表评估试验质量，并提取数据。向试验者寻求更多信息。计算相关二分法结局的比值比和99%置信区间，并以图表形式呈现。
仅识别出一项针对90例转子区不稳定髋关节囊外股骨骨折患者的随机试验，并纳入本综述。该试验比较了关节成形术与滑动髋螺钉，方法学质量较差。从该试验可得的有限数据来看，两种治疗方法在手术时间、局部伤口并发症、死亡率或既往独立患者的活动能力方面无显著差异。然而，据报道关节成形术组的输血需求更高。
随机试验证据不足，无法确定置换关节成形术在治疗髋关节囊外骨折方面是否比滑动髋螺钉有任何优势。需要进一步设计良好的随机试验来比较这些骨折的治疗方法。
