骨水泥型和非骨水泥型人工关节置换术治疗囊内型髋关节骨折的有效性和安全性。
Effectiveness and safety of cemented and uncemented hemiarthroplasty in the treatment of intracapsular hip fractures.
机构信息
Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
出版信息
Bone Joint J. 2020 Sep;102-B(9):1113-1121. doi: 10.1302/0301-620X.102B9.BJJ-2020-0282.R1.
AIMS
We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately.
METHODS
PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures.
RESULTS
A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty.
CONCLUSION
There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: 2020;102-B(9):1113-1121.
目的
我们进行了一项系统评价和荟萃分析，比较了在治疗囊内髋部骨折时使用骨水泥固定和非骨水泥固定半髋关节置换术的死亡率、发病率和功能结局，并分别对当代和非当代植入物进行分析。
方法
检索了 PubMed、Medline、EMBASE、CINAHL 和 Cochrane Library，截至 2020 年 2 月 2 日，以比较随机对照试验（RCT）的主要结局、死亡率以及功能、生活质量、再次手术、术后并发症、围手术期结局、疼痛和住院时间等次要结局。使用相对风险（RR）和平均差异（95%置信区间（CI））作为汇总关联度量。
结果
共纳入了 18 项研究，涉及 16 项非重叠的 RCT，共纳入了 2819 例囊内髋部骨折。与当代骨水泥固定相比，非骨水泥固定半髋关节置换术的围手术期死亡率 RR（95%CI）为 1.32（0.44 至 3.99），30 天死亡率 RR 为 1.01（0.48 至 2.10），1 年死亡率 RR 为 0.90（0.71 至 1.15）。使用当代骨水泥固定半髋关节置换术可降低术中及术后假体周围骨折的风险。其他并发症、功能、疼痛和生活质量的风险无显著差异。除了当代骨水泥固定半髋关节置换术的手术时间和总麻醉时间分别增加了 6.67（2.65 至 10.68）和 4.90（2.02 至 7.78）分钟外，围手术期结局的风险无显著差异，这些差异的 95%CI 分别为 6.67（2.65 至 10.68）和 4.90（2.02 至 7.78）分钟。非当代骨水泥固定和非骨水泥固定半髋关节置换术的发病率和死亡率无显著差异。
结论
在治疗囊内髋部骨折时，与使用非骨水泥固定半髋关节置换术相比，使用当代骨水泥固定半髋关节置换术的死亡率无显著差异。当代骨水泥固定半髋关节置换术与术中及假体周围骨折的风险显著降低相关。
文献来源：Tasdelen MA, Bayraktar HH, Yilmaz C, et al. Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2020;102-B(9):1113-1121.
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