Sims A L, Farrier A J, Reed M R, Sheldon T A
Northumbria NHS Foundation Trust, Unit 78 Silver Fox Way, Cobalt Business Park, Newcastle upon Tyne NE12 8EW, UK
Northumbria NHS Foundation Trust, Unit 78 Silver Fox Way, Cobalt Business Park, Newcastle upon Tyne NE12 8EW, UK.
Bone Joint Res. 2017 Aug;6(8):506-513. doi: 10.1302/2046-3758.68.BJR-2016-0256.R1.
The objective of this study was to assess all evidence comparing the Thompson monoblock hemiarthroplasty with modular unipolar implants for patients requiring hemiarthroplasty of the hip with respect to mortality and complications.
A literature search was performed to identify all relevant literature. The population consisted of patients undergoing hemiarthroplasty of the hip for fracture. The intervention was hemiarthroplasty of the hip with a comparison between Thompson and modular unipolar prostheses.Pubmed, Embase, CINAHL, Web of Science, PROSPERO and the Cochrane Central Register of Controlled Trials.The study designs included were randomised controlled trials (RCTs), well designed case control studies and retrospective or prospective cohort studies. Studies available in any language, published at any time until September 2015 were considered. Studies were included if they contained mortality or complications.
The initial literature search identified 4757 items for examination. Four papers were included in the final review. The pooled odds ratio for mortality was 1.3 (95% confidence Interval 0.78 to 2.46) favouring modular designs. The pooled odds ratio for post-operative complications was 1.1 (95% CI 0.79 to 1.55) favouring modular designs. Outcomes were reported at 12 or six months. These papers all contained potential sources of bias and significant clinical heterogeneity.
The current evidence comparing monoblock modular implants in patients undergoing hemiarthroplasty is weak. Confidence intervals around the pooled odds ratios are broad and incorporate a value of one. Direct comparison of outcomes from these papers is fraught with difficulty and, as such, may well be misleading. A well designed randomised controlled trial would be helpful to inform evidence-based implant selection.: A. L. Sims, A. J. Farrier, M. R. Reed, T. A. Sheldon. Thompson hemiarthroplasty modular unipolar implants for patients requiring hemiarthroplasty of the hip: A systematic review of the evidence. 2017;6:-513. DOI: 10.1302/2046-3758.68.BJR-2016-0256.R1.
本研究的目的是评估所有关于Thompson一体式半髋关节置换术与模块化单极植入物用于需要进行髋关节半髋关节置换术的患者的死亡率和并发症的比较证据。
进行文献检索以识别所有相关文献。研究对象为接受髋关节骨折半髋关节置换术的患者。干预措施为髋关节半髋关节置换术，并比较Thompson假体和模块化单极假体。检索了PubMed、Embase、CINAHL、Web of Science、PROSPERO以及Cochrane对照试验中央注册库。纳入的研究设计包括随机对照试验（RCT）、设计良好的病例对照研究以及回顾性或前瞻性队列研究。考虑了截至2015年9月以任何语言发表的任何时间的研究。如果研究包含死亡率或并发症则纳入。
初步文献检索确定了4757篇待审查的文献。最终综述纳入了4篇论文。死亡率的合并优势比为1.3（95%置信区间0.78至2.46），支持模块化设计。术后并发症的合并优势比为1.1（95%CI 0.79至1.55），支持模块化设计。结果在12个月或6个月时报告。这些论文均包含潜在的偏倚来源和显著的临床异质性。
目前比较接受半髋关节置换术患者中一体式与模块化植入物的证据不足。合并优势比周围的置信区间很宽且包含1的值。直接比较这些论文的结果充满困难，因此可能会产生误导。一项设计良好的随机对照试验将有助于为基于证据的植入物选择提供信息。：A.L. Sims、A.J. Farrier、M.R. Reed、T.A. Sheldon。Thompson半髋关节置换术与模块化单极植入物用于需要进行髋关节半髋关节置换术的患者：证据的系统评价。2017；6：-513。DOI：10.1302/2046-3758.68.BJR-2016-0256.R1。
