School of Mathematics, Jilin University, Changchun, Jilin Province, China.
Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
J Orthop Surg Res. 2020 Sep 21;15(1):433. doi: 10.1186/s13018-020-01958-2.
Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors.
Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared.
There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up.
In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.
股骨颈骨折是老年人常见的骨折。常见的治疗选择包括内固定（IF）和人工半髋关节置换术（HA）。然而，由于潜在的临床创伤、术后功能、早期并发症等因素，这两种选择的临床应用一直存在争议。
从 PubMed、Web of Science、EMBASE 和 Cochrane 等数据库中提取比较老年移位股骨颈骨折患者螺钉固定与人工半髋关节置换的随机对照试验和队列研究。使用修订后的 Jadad 量表或 NOS 治疗评估表评估纳入研究的质量。提取数据后，使用连续数据的标准差和二项数据的相对风险来比较手术时间、手术过程中的失血量、EQ-5D（欧洲五维健康量表）评分、死亡率、再次手术率和术后常见并发症。使用 Review Manager 软件（RevMan 5.3）进行评价。
共纳入 7 项随机对照试验和 5 项队列研究。结果显示，内固定组的手术时间、术中出血量和短期 EQ-5D 评分均低于半髋关节置换组，但再次手术率较高。在短期随访中，死亡率和常见并发症（如深静脉血栓形成、肺栓塞、感染和压疮）无统计学差异。
在治疗老年股骨颈骨折时，螺钉内固定组的手术时间更短，术中出血量更少，围手术期优势更为明显。然而，半髋关节置换组在术后功能评分和再次手术方面具有更多优势。
