Parker M J, Handoll H H
Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA.
Cochrane Database Syst Rev. 2000(2):CD000337. doi: 10.1002/14651858.CD000337.
Until operative treatment involving the use of various implants was introduced in the 1950s, hip fractures were managed using conservative methods based on traction and bed rest.
To compare conservative with operative treatment for extracapsular fractures of the proximal femur (hip) in adults.
We searched the Cochrane Musculoskeletal Injuries Group trials register and bibliographies of published papers, and contacted trialists. Date of the most recent search: August 1999.
Randomised and quasi-randomised trials comparing these two treatment methods in adults with hip fracture. Outcomes sought fell into four categories: a) fracture fixation complications, b) post-operative or clinical complications, c) final outcome measures including mortality and d) anatomical restoration.
Both reviewers independently assessed trial quality, by use of an eleven item scale, and extracted data. Additional information was sought from trialists. Comparable groups of trials were subgrouped by implant type (fixed nail plate or sliding hip screw) and where appropriate, data were pooled using the fixed effects model.
The four randomised trials identified involved only 402 elderly patients. These tested a variety of surgical techniques and implant devices and only one trial involving 106 patients can be considered to test current practice. In this trial, no differences were found in medical complications, mortality and long-term pain. However, operative treatment was more likely to result in the fracture healing without leg shortening, a shorter hospital stay and a statistically non-significant increase in the return of patients back to their original residence.
REVIEWER'S CONCLUSIONS: The limited available evidence from randomised trials does not suggest major differences in outcome between conservative and operative management programmes for extracapsular femoral fractures, but operative treatment appears to be associated with a reduced length of hospital stay and improved rehabilitation. However these results are derived mainly from one study. Conservative treatment will be acceptable where modern surgical facilities are unavailable, and will result in a reduction in complications associated with surgery, but rehabilitation is likely to be slower and limb deformity more common. Although further randomised trials would provide more robust data, they may be difficult to mount.
在20世纪50年代引入涉及使用各种植入物的手术治疗之前，髋部骨折采用基于牵引和卧床休息的保守方法进行处理。
比较成人股骨近端（髋部）囊外骨折的保守治疗与手术治疗。
我们检索了Cochrane肌肉骨骼损伤组试验注册库和已发表论文的参考文献，并联系了试验者。最近一次检索日期：1999年8月。
比较这两种治疗方法在成人髋部骨折中的随机和半随机试验。所寻求的结果分为四类：a）骨折固定并发症，b）术后或临床并发症，c）包括死亡率在内的最终结果测量，d）解剖复位。
两位综述作者均使用11项量表独立评估试验质量，并提取数据。向试验者寻求更多信息。将可比的试验组按植入物类型（固定钉板或滑动髋螺钉）进行亚组分类，并在适当情况下，使用固定效应模型汇总数据。
所确定的四项随机试验仅涉及402名老年患者。这些试验测试了多种手术技术和植入装置，只有一项涉及106名患者的试验可被视为测试当前的治疗方法。在该试验中，在医疗并发症、死亡率和长期疼痛方面未发现差异。然而，手术治疗更有可能使骨折愈合且无腿部缩短，住院时间更短，患者返回原居住地的比例有统计学上不显著的增加。
随机试验中有限的现有证据并未表明股骨囊外骨折的保守治疗和手术治疗方案在结果上有重大差异，但手术治疗似乎与缩短住院时间和改善康复有关。然而，这些结果主要来自一项研究。在没有现代手术设施的情况下，保守治疗是可以接受的，并且将减少与手术相关的并发症，但康复可能较慢且肢体畸形更常见。尽管进一步的随机试验将提供更可靠的数据，但可能难以开展。
