Minnesota Evidence-based Practice Center, School of Public Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455, USA.
J Bone Joint Surg Am. 2011 Jun 15;93(12):1104-15. doi: 10.2106/JBJS.J.00296.
There is a growing body of literature on surgical treatments for elderly patients with a hip fracture and the effects of various surgical procedures on complications and postoperative outcomes. No single review has previously summarized the literature on the effects of surgical procedures on outcomes after treatment across all types of hip fractures. We conducted a comprehensive systematic literature review to organize the clinical evidence for patient-centered outcomes across all types of geriatric hip fractures.
We searched MEDLINE, the Cochrane Database of Systematic Reviews, Scirus, and ClinicalTrials.gov for randomized clinical trials and observational studies published between 1985 and 2008. We also manually searched reference lists from relevant systematic reviews.
We found eighty-four [corrected] articles representing seventy-four [corrected] unique, randomized, controlled trials, including thirty-three [corrected] on femoral neck fractures, forty on intertrochanteric fractures, and one on subtrochanteric fractures. Nine observational studies addressed the link between patient characteristics and outcome variables by fracture type. Age, sex, prefracture functioning, and cognitive impairment are related to mortality and functional outcomes. Fracture type does not appear to be independently related to patient outcomes. Mortality, pain, function, and quality of life did not differ by surgical implant class, or by implants within a class. Neither the randomized controlled trials nor the observational literature include the full complement of potential covariates that can impact treatment outcomes after treatment.
The broader questions about the relationship of patient factors, fracture type, and specific treatments to the outcomes of mortality, functional status, and quality of life cannot be addressed with the existing literature. Research should include comprehensive conceptual models that capture complete sets of important independent variables. Studies of musculoskeletal outcomes, including hip fracture, require well-defined patient groups and consistent use of validated outcome measures.
越来越多的文献关注老年髋部骨折患者的手术治疗以及各种手术方法对并发症和术后结果的影响。目前尚无单一的综述总结过各种手术方法对所有类型髋部骨折治疗后结果的影响。我们进行了一项全面的系统文献回顾，旨在整理所有类型老年髋部骨折患者以患者为中心的结局的临床证据。
我们检索了 MEDLINE、Cochrane 系统评价数据库、Scirus 和 ClinicalTrials.gov，以寻找 1985 年至 2008 年期间发表的随机临床试验和观察性研究。我们还人工检索了相关系统评价的参考文献列表。
我们找到了 84 篇[纠正]文章，代表了 74 项[纠正]独特的随机对照试验，其中 33 项涉及股骨颈骨折，40 项涉及转子间骨折，1 项涉及转子下骨折。9 项观察性研究通过骨折类型探讨了患者特征与结局变量之间的关系。年龄、性别、骨折前功能以及认知障碍与死亡率和功能结局相关。骨折类型似乎与患者结局无独立关系。死亡率、疼痛、功能和生活质量不因手术植入物类型或同一类植入物的不同而不同。随机对照试验和观察性文献均未包含可能影响治疗后治疗结局的全部潜在协变量。
现有文献无法解决患者因素、骨折类型和特定治疗方法与死亡率、功能状态和生活质量结局之间关系的更广泛问题。研究应包括能够捕捉到所有重要自变量的全面概念模型。包括髋部骨折在内的肌肉骨骼结局研究需要明确界定的患者群体和对经过验证的结局测量方法的一致使用。
