Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
PLoS One. 2013 Jul 23;8(7):e68903. doi: 10.1371/journal.pone.0068903. Print 2013.
Controversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 70 years old.
We searched PUBMED, EMBASE, Cochrane Library, CNKI and VIP Database from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.
7 RCTs involving 1,125 patients (1,125 hips) were eligible for meta-analysis. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31-0.76; P = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29-0.64; P<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09-0.26; P<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37-9.49 min; P<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.
Compared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.
对于老年股骨颈骨折患者，骨水泥型或非骨水泥型半髋关节置换术的效果仍存在争议。本研究旨在比较两种手术技术在 70 岁以上股骨颈骨折患者中的有效性和安全性。
我们检索了 PUBMED、EMBASE、Cochrane Library、中国知网（CNKI）和维普数据库（VIP Database），检索时间从建库至 2012 年 12 月，以获取相关的随机对照试验（RCTs）。主要结局指标包括术后髋关节功能、残留疼痛、并发症发生率、死亡率、再次手术率、手术时间和术中失血量。根据纳入研究的异质性，采用随机效应模型或固定效应模型对每项试验的比值比（OR）和加权均数差（WMD）进行合并。
共纳入 7 项 RCTs，包含 1125 名患者（1125 髋）。Meta 分析结果显示，骨水泥型半髋关节置换术术后髋关节功能更好（OR=0.48，95%CI，0.31-0.76；P=0.002），残留疼痛更低（OR=0.43，95%CI，0.29-0.64；P<0.0001），假体相关并发症更少（OR=0.15，95%CI，0.09-0.26；P<0.00001），手术时间更长（WMD=7.43 min，95%CI，5.37-9.49 min；P<0.00001）。两组患者死亡率、心血管和脑血管并发症、局部并发症、全身并发症、再次手术率和术中失血量无显著差异。
与非骨水泥型半髋关节置换术相比，现有证据表明骨水泥型半髋关节置换术可改善老年股骨颈骨折患者的髋关节功能，减轻残留疼痛，减少假体相关并发症，但不增加死亡率、心血管和脑血管并发症、全身并发症、局部并发症和再次手术率。
