Liu Binfeng, Li Ang, Wang Jialin, Wang Hongbo, Zhai Gongwei, Ma Haohao, Lian Xiaoyu, Zhang Bo, Liu Liyun, Gao Yanzheng
Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China.
Medicine (Baltimore). 2020 Aug 14;99(33):e21731. doi: 10.1097/MD.0000000000021731.
This meta-analysis was performed to incorporate newly published, high-quality randomized controlled trials (RCTs) to determine the effects of cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck.
The following electronic databases were extensively searched from the inception of the database through December 2018: EMBASE, Medline, the Cochrane Library, and Web of Science. RCTs focusing on the outcomes of cemented and uncemented hemiarthroplasty were reviewed and screened for eligibility. We used the Cochrane Collaboration's Review Manager Software to perform meta-analyses. Two independent reviewers extracted the data and assessed the study quality and bias risk through the Cochrane Collaboration tool. Use fixed effect model or random effect model to pooled data. Cochran's Q statistic was used to evaluate heterogeneity, and I statistic was used to quantify heterogeneity.
Fifteen RCTs were enrolled (n = 3790) (uncemented hemiarthroplasty group = 1015; cemented hemiarthroplasty group = 1037) (mean age ranged from 70-85.3 years; all patients > 65 years). The meta-analysis showed that cemented hemiarthroplasty has a longer operating time (weighted mean difference, 8.03; 95% confidence interval (CI) 4.83-11.23; P < .00001), less pain (odds ratio, 0.48; 95% CI 4.83-11.23; P = .02), lower mortality 1-year (odds ratio, 0.78; 95% CI 0.62-0.98; P = .03) and fewer implant-related complications (odds ratio, 0.20; 95% CI 0.13-0.30; P < .00001) than Uncemented hemiarthroplasty. However, there are still some limitations in our study, such as the uniformity of the surgery administration programme and rehabilitation scheme, and the small sample size of the included studies.
Cemented hemiarthroplasty for elderly patients with displaced fracture of femoral neck may acquire better functional results.
本荟萃分析纳入新发表的高质量随机对照试验（RCT），以确定骨水泥型与非骨水泥型半髋关节置换术治疗老年股骨颈移位骨折患者的效果。
从各数据库建库起至2018年12月，对以下电子数据库进行全面检索：EMBASE、Medline、Cochrane图书馆和科学网。对聚焦于骨水泥型与非骨水泥型半髋关节置换术结局的RCT进行综述和筛选以确定其是否符合纳入标准。我们使用Cochrane协作网的Review Manager软件进行荟萃分析。两名独立的审阅者提取数据，并通过Cochrane协作工具评估研究质量和偏倚风险。使用固定效应模型或随机效应模型合并数据。使用Cochran's Q统计量评估异质性，并用I统计量量化异质性。
共纳入15项RCT（n = 3790）（非骨水泥型半髋关节置换术组 = 1015；骨水泥型半髋关节置换术组 = 1037）（平均年龄70 - 85.3岁；所有患者>65岁）。荟萃分析表明，与非骨水泥型半髋关节置换术相比，骨水泥型半髋关节置换术的手术时间更长（加权平均差，8.03；95%置信区间（CI）4.83 - 11.23；P <.00001），疼痛更轻（比值比，0.48；95%CI 4.83 - 11.23；P =.02），1年死亡率更低（比值比0.78；95%CI 0.62 - 0.98；P =.03），植入物相关并发症更少（比值比，0.20；95%CI 0.13 - 0.30；P <.00001）。然而，我们的研究仍存在一些局限性，如手术实施方案和康复方案的一致性，以及纳入研究的样本量较小。
对于老年股骨颈移位骨折患者，骨水泥型半髋关节置换术可能获得更好的功能结果。
