Tseng Feng-Jen, Chia Wei-Tso, Pan Ru-Yu, Lin Leou-Chyr, Shen Hsian-Chung, Wang Chih-Hung, Shyu Jia-Fwu, Weng Ching-Feng
Department of Life Science and the Institute of Biotechnology, National Dong Hwa University, Hualien, 974, Taiwan, Republic of China.
Department of Orthopedics, Hualien Armed Force General Hospital, Hualien, 971, Taiwan, Republic of China.
J Orthop Surg Res. 2017 Sep 15;12(1):131. doi: 10.1186/s13018-017-0629-5.
This meta-analysis compared clinical outcomes of arthroplasty vs. osteosynthesis for displaced femoral neck fractures.
Meta-analysis was performed on the difference in revision rate and overall mortality between participants undergoing osteosynthesis vs. total hip arthroplasty (THA), osteosynthesis vs. hemiarthroplasty (HA), or THA vs. HA.
Pooled direct and indirect results indicated no significant difference in mortality between THA and HA (pooled OR = 0.87, 95% CI 0.55 to 1.38; P = 0.556), between THA and osteosynthesis (pooled OR = 1.17, 95% CI 0.69 to 1.99; P = 0.553), and between HA and osteosynthesis (pooled OR = 1.21, 95% CI 0.84 to 1.74; P = 0.304). Pooled direct and indirect results indicated no significant difference in revision rates between THA and HA (pooled OR = 0.90, 95% CI 0.26 to 3.19; P = 0.874). But, fewer revisions (OR = 0.19, 95% CI 0.10 to 0.34; P = 0.000) were seen in patients treated with THA than osteosynthesis and also in those treated with HA than osteosynthesis (OR = 0.12, 95% CI 0.07 to 0.20; P = 0.000). After excluding studies without showing normal cognition in inclusion criteria, pooled direct and indirect results also indicated no significant difference in mortality between THA, HA, and osteosynthesis. Similarly, there was no significant difference in revision rates between THA and HA, but HA and THA had significantly lower revision rates compared with osteosynthesis.
There was no significant difference in overall mortality among osteosynthesis, HA, and THA. However, HA and THA had significantly lower revision rates compared with osteosynthesis. Results of the present study provide support for the use of hip arthroplasty to treat displaced fractures of the femoral neck.
本荟萃分析比较了置换术与接骨术治疗移位型股骨颈骨折的临床结局。
对接受接骨术与全髋关节置换术（THA）、接骨术与半髋关节置换术（HA）或THA与HA的参与者之间的翻修率和总死亡率差异进行荟萃分析。
汇总的直接和间接结果表明，THA与HA之间的死亡率无显著差异（汇总OR = 0.87，95%CI为0.55至1.38；P = 0.556），THA与接骨术之间无显著差异（汇总OR = 1.17，95%CI为0.69至1.99；P = 0.553），HA与接骨术之间无显著差异（汇总OR = 1.21，95%CI为0.84至1.74；P = 0.304）。汇总的直接和间接结果表明，THA与HA之间的翻修率无显著差异（汇总OR = 0.90，95%CI为0.26至3.19；P = 0.874）。但是，接受THA治疗的患者的翻修次数少于接受接骨术治疗的患者（OR = 0.19，95%CI为0.10至0.34；P = 0.000），接受HA治疗的患者也是如此（OR = 0.12，95%CI为0.07至0.20；P = 0.000）。在排除纳入标准中未显示正常认知的研究后，汇总的直接和间接结果还表明，THA、HA和接骨术之间的死亡率无显著差异。同样，THA与HA之间的翻修率无显著差异，但HA和THA的翻修率明显低于接骨术。
接骨术、HA和THA的总死亡率无显著差异。然而，HA和THA的翻修率明显低于接骨术。本研究结果为使用髋关节置换术治疗移位型股骨颈骨折提供了支持。
