Li Na, Zhong Lei, Wang Chang, Xu Meng, Li Wei
Department of Orthopedics, The Second Hospital of Jilin University.
Center for Applied Statistical Research and College of Mathematics, Jilin University.
Medicine (Baltimore). 2020 Feb;99(8):e19039. doi: 10.1097/MD.0000000000019039.
To compare the efficacy and safety of cemented and uncemented hemiarthroplasty in elderly patients with femoral neck fracture.
We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with uncemented hemiarthroplasty in elderly patients with a femoral neck fracture. The search was not limited to language, time, or other factors. The quality of each study was assessed using the revised Jadad scale. Two researchers independently extracted data from all selected studies, including the following base line data: study period, fracture stage, number of patients, male female ratio, average age, and per-protocol (PP) or intent-to-treat (ITT), and the interest outcomes: the mortality at 12 months, operative time, hospital stay, common complications, prosthetic-related complications, blood loss and Harris Hip Score (HHS). Fixed-effects or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine heterogeneity of the included studies.
A total of 8 studies involving 1577 hips (782 uncemented and 795 cemented) were included in this meta-analysis. The meta-analysis is indicated that the operation time of cemented hemiarthroplasty was longer than uncemented hemiarthroplasty and there was statistical significance between two groups (OR = -7.30, 95%CI, -13.13, -1.46; P = .01). However, there was no significant difference between the two methods of fixation in mortality at 12 months (OR = 1.22, 95%CI, 0.94-1.59; P = .14), hospital stay (OR = 0.26, 95%CI, -0.41, 0.93; P = .44), blood loss (OR = -17.94, 95%CI, -65.83, 29.95; P = .46), and HHS score. There were significant differences in the common complications of pulmonary embolism between the two groups, but there were no differences in the other five common complications. The results showed that uncemented hemiarthroplasty could reduce the incidence of pulmonary embolism after operation. Moreover, the outcomes of prosthetic-related complications showed that there were significant differences between the two groups in periprosthetic fracture (OR = 8.32, 95%CI, 3.85-17.98; P < .00001) and prosthetic subsidence and loosening (OR = 5.33, 95%CI, 2.18-13.00; P = .0002).
Our study shows that uncemented prosthesis can shorten the operation time and reduce the incidence of pulmonary embolism, but it does not reduce mortality, blood loss, and hospital stay. Most importantly, the incidence of prosthetic-related complications was higher in uncemented patients.
比较骨水泥型与非骨水泥型半髋关节置换术治疗老年股骨颈骨折患者的疗效和安全性。
检索PubMed、EMBASE和Cochrane图书馆数据库，查找比较骨水泥型半髋关节置换术与非骨水泥型半髋关节置换术治疗老年股骨颈骨折患者的已发表随机临床试验。检索不限于语言、时间或其他因素。使用修订的Jadad量表评估每项研究的质量。两名研究人员独立从所有选定研究中提取数据，包括以下基线数据：研究期间、骨折分期、患者数量、男女比例、平均年龄以及符合方案集（PP）或意向性分析（ITT），以及关注的结局：12个月时的死亡率、手术时间、住院时间、常见并发症、假体相关并发症、失血量和Harris髋关节评分（HHS）。采用固定效应或随机效应模型，以均值差和比值比汇总连续变量和二分变量，以确定纳入研究的异质性。
本荟萃分析共纳入8项研究，涉及1577例髋关节（782例非骨水泥型和795例骨水泥型）。荟萃分析表明，骨水泥型半髋关节置换术的手术时间长于非骨水泥型半髋关节置换术，两组间有统计学意义（OR = -7.30，95%CI，-13.13，-1.46；P = 0.01）。然而，两种固定方法在12个月时的死亡率（OR = 1.22，95%CI，0.94 - 1.59；P = 0.14）、住院时间（OR = 0.26，95%CI，-0.41，0.93；P = 0.44）、失血量（OR = -17.94，95%CI，-65.83，29.95；P = 0.46）和HHS评分方面无显著差异。两组在肺栓塞的常见并发症方面有显著差异，但在其他五种常见并发症方面无差异。结果表明，非骨水泥型半髋关节置换术可降低术后肺栓塞的发生率。此外，假体相关并发症的结果表明，两组在假体周围骨折（OR = 8.32，95%CI，3.85 - 17.98；P < 0.00001）以及假体下沉和松动（OR = 5.33，95%CI，2.18 - 13.00；P = 0.0002）方面有显著差异。
我们的研究表明，非骨水泥型假体可缩短手术时间并降低肺栓塞的发生率，但不能降低死亡率、失血量和住院时间。最重要的是，非骨水泥型患者假体相关并发症的发生率更高。
