Parker M J, Handoll H H G
Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA.
Cochrane Database Syst Rev. 2006 Apr 19;2006(2):CD000086. doi: 10.1002/14651858.CD000086.pub2.
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 Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles.
Randomised and quasi-randomised trials comparing replacement arthroplasty with an internal fixation implant for adults with an extracapsular hip fracture.
Both review authors independently assessed 10 aspects of trial quality and extracted data. We requested additional information from trial investigators. Where appropriate, limited pooling of data was performed.
Two randomised controlled trials including a total of 148 people aged 70 years or over with unstable extracapsular hip fractures in the trochanteric region were identified and included in this review. Both had methodological limitations, including inadequate assessment of longer-term outcome. One trial compared a cemented arthroplasty with a sliding hip screw. This found no significant differences between the two methods of treatment for operating time, local wound complications, mechanical complications, reoperation, mortality or loss of independence of previously independent patients at one year. There was, however, a higher blood transfusion need in the arthroplasty group. The other trial compared a cementless arthroplasty versus a proximal femoral nail. It also found a higher blood transfusion need in the arthroplasty group, together with a greater operative blood loss, and a longer length of surgery. There were no significant differences between the two interventions for mechanical complications, local wound complications, reoperation, general complications, mortality at one year or long-term function. None of the pooled outcome data yielded statistically significant differences between the arthroplasty and internal fixation, with the exception of the significantly higher numbers of participants in the arthroplasty group requiring blood transfusion (relative risk 1.71, 95% confidence interval 1.05 to 2.77).
AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over internal fixation for extracapsular hip fractures. Further larger well-designed randomised trials comparing arthroplasty versus internal fixation for the treatment of unstable fractures 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。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。
比较关节置换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骨、关节和肌肉创伤组专业注册库（2005年12月）、Cochrane对照试验中央注册库（Cochrane图书馆2005年第4期）、MEDLINE、EMBASE、英国国家研究注册库、几本骨科杂志、会议论文集以及文章的参考文献列表。
比较关节置换术与内固定植入物治疗成人髋关节囊外骨折的随机和半随机试验。
两位综述作者独立评估试验质量的10个方面并提取数据。我们向试验研究者索要了额外信息。在适当情况下，进行了有限的数据合并。
确定了两项随机对照试验，共纳入148名70岁及以上转子区不稳定髋关节囊外骨折患者。两项试验均存在方法学局限性，包括对长期结局评估不足。一项试验比较了骨水泥型关节置换术与滑动髋螺钉。结果发现，两种治疗方法在手术时间、局部伤口并发症、机械并发症、再次手术、死亡率或一年时之前独立患者的独立性丧失方面无显著差异。然而，关节置换术组输血需求更高。另一项试验比较了非骨水泥型关节置换术与股骨近端髓内钉。结果还发现，关节置换术组输血需求更高，手术失血量更大，手术时间更长。两种干预措施在机械并发症、局部伤口并发症、再次手术、一般并发症、一年时的死亡率或长期功能方面无显著差异。除关节置换术组需要输血的参与者数量显著更多外（相对风险1.71，95%置信区间1.05至2.77），合并的结局数据在关节置换术和内固定术之间均未产生统计学显著差异。
随机试验证据不足，无法确定关节置换术在治疗髋关节囊外骨折方面是否比内固定术有任何优势。需要进一步开展更大规模、设计良好的随机试验，比较关节置换术与内固定术治疗不稳定骨折的效果。
