Kong Xiangan
Department of Orthopaedics, The Second People's Hospital of Hefei, Hefei, Anhui 230011, P.R. China.
Exp Ther Med. 2020 Sep;20(3):2173-2183. doi: 10.3892/etm.2020.8921. Epub 2020 Jun 22.
The present meta-analysis was designed to systematically evaluate the effect of cemented and uncemented hemiarthroplasty on femoral neck fractures in the elderly and its effect on intraoperative bleeding and postoperative complications. Pubmed, Embase, the Cochrane Library, CNKI and WANFANG databases were retrieved and retrieval time was from inception to February 2019. Operative time, intraoperative blood loss, length of hospital stay, postoperative complications and postoperative mortality were compared between cemented and uncemented hemiarthroplasty. RevMan 5.3 statistical software was used for analysis. A total of 16 randomized controlled trials were included, with a total of 2,384 patients undergoing hemiarthroplasty. The cemented group had a longer operation time [weighted mean difference (WMD)=7.07, 95% confidence interval (CI)=3.91-10.23, P<0.0001], but it had lower incidence of intraoperative and postoperative fracture around the prosthesis (OR=0.25, 95% CI=0.13-0.47, P<0.0001) and shorter length of hospital stay (WMD=-1.78, 95% CI=-13.38--0.17, P=0.03). There was no significant difference in pulmonary embolism, mortality, lower extremity deep vein thrombosis rate, joint dislocation rate, intraoperative blood loss and postoperative incidence of lung, urinary system and incision infection between the two groups. To summarize, compared with the uncemented group, the cemented group had long operation time and a high incidence of pulmonary embolism, but had an advantage in reducing the risk of periprosthetic fractures. In addition, cemented hemiarthroplasty did not increase the mortality rate, the rate of deep vein thrombosis in lower extremities, the rate of joint dislocation, intraoperative blood loss, and the incidence of postoperative pulmonary, urinary, and incision infections.
本荟萃分析旨在系统评价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的效果及其对术中出血和术后并发症的影响。检索了PubMed、Embase、Cochrane图书馆、中国知网和万方数据库，检索时间从建库至2019年2月。比较了骨水泥型与非骨水泥型半髋关节置换术的手术时间、术中失血量、住院时间、术后并发症及术后死亡率。采用RevMan 5.3统计软件进行分析。共纳入16项随机对照试验，共有2384例患者接受半髋关节置换术。骨水泥组手术时间较长[加权均数差（WMD）=7.07，95%置信区间（CI）=3.91-10.23，P<0.0001]，但假体周围术中和术后骨折发生率较低（OR=0.25，95%CI=0.13-0.47，P<0.0001），住院时间较短（WMD=-1.78，95%CI=-13.38--0.17，P=0.03）。两组在肺栓塞、死亡率、下肢深静脉血栓形成率、关节脱位率、术中失血量以及肺部、泌尿系统和切口感染的术后发生率方面无显著差异。综上所述，与非骨水泥组相比，骨水泥组手术时间长，肺栓塞发生率高，但在降低假体周围骨折风险方面具有优势。此外，骨水泥型半髋关节置换术并未增加死亡率、下肢深静脉血栓形成率、关节脱位率、术中失血量以及术后肺部、泌尿系统和切口感染的发生率。
