Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany.
PLoS One. 2021 Jun 15;16(6):e0251894. doi: 10.1371/journal.pone.0251894. eCollection 2021.
To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (>65 years) following low energy trauma.
PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. Subgroup analysis was performed stratified by study design (RCTs and observational studies). The primary outcome is overall complication rate. Secondary outcomes include re-operation rate, mortality, operation duration, hospital stay, general quality of life, radiologic measures and functional hip scores.
A total of four RCT's (437 patients) and three observational studies (293 patients) were included. The effect estimates of RCTs were equal to those obtained from observational studies. Cement augmentation has a significantly lower overall complication rate (28.3% versus 47.2%) with an odds ratio (OR) of 0.3 (95%CI 0.1-0.7). The occurrence of device/fracture related complications was the largest contributing factor to this higher overall complication rate in the non-augmented group (19.9% versus 6.0%, OR 0.2, 95%CI 0.1-0.6). Cement augmentation also carries a lower risk for re-interventions (OR 0.2, 95%CI 0.1-0.7) and shortens the hospital stay with 2 days (95%CI -2.2 to -0.5 days). The mean operation time was 7 minutes longer in the augmented group (95%CI 1.3-12.9). Radiological scores (lag screw/blade sliding mean difference -3.1mm, 95%CI -4.6 to -1.7, varus deviation mean difference -6.15°, 95%CI; -7.4 to -4.9) and functional scores (standardized mean difference 0.31, 95%CI 0.0-0.6) were in favor of cement augmentation. Mortality was equal in both groups (OR 0.7, 95%CI 0.4-1.3) and cement related complications were rare.
Cement augmentation in fixation of trochanteric femoral fractures leads to fewer complications, re-operations and shorter hospital stay at the expense of a slightly longer operation duration. Cementation related complications occur rarely and mortality is equal between treatment groups. Based on these results, cement augmentation should be considered for trochanteric fractures in elderly patients.
目前，尚不清楚在治疗老年（>65 岁）低能量创伤性转子间骨折时，骨水泥增强固定的临床获益是什么。本荟萃分析旨在比较骨水泥增强与非增强固定在老年患者转子间股骨骨折中的作用。
通过检索 PubMed/Medline/Embase/CENTRAL/CINAHL，纳入比较两种治疗方法的随机临床试验（RCT）和观察性研究。使用随机效应模型对研究间的效应估计值进行合并。根据研究设计（RCT 和观察性研究）进行分层亚组分析。主要结局是总体并发症发生率。次要结局包括再次手术率、死亡率、手术时间、住院时间、总体生活质量、影像学测量和髋关节功能评分。
共纳入 4 项 RCT（437 例患者）和 3 项观察性研究（293 例患者）。RCT 的效应估计值与观察性研究的结果相当。骨水泥增强固定的总体并发症发生率明显较低（28.3%对 47.2%），优势比（OR）为 0.3（95%CI 0.1-0.7）。非增强组中设备/骨折相关并发症发生率较高是导致总体并发症发生率较高的最大因素（19.9%对 6.0%，OR 0.2，95%CI 0.1-0.6）。骨水泥增强固定还可降低再次干预的风险（OR 0.2，95%CI 0.1-0.7），并将住院时间缩短 2 天（95%CI -2.2 至 -0.5 天）。增强组的平均手术时间延长 7 分钟（95%CI 1.3-12.9）。影像学评分（尾钉/刀片滑动平均差值-3.1mm，95%CI -4.6 至 -1.7，内翻偏差平均差值-6.15°，95%CI -7.4 至 -4.9）和功能评分（标准化均数差 0.31，95%CI 0.0-0.6）均倾向于骨水泥增强固定。两组死亡率相当（OR 0.7，95%CI 0.4-1.3），且与骨水泥相关的并发症罕见。
在固定转子间股骨骨折时，骨水泥增强固定可减少并发症、再次手术和住院时间，但手术时间稍长。与骨水泥相关的并发症很少见，且两组的死亡率相当。基于这些结果，应考虑在老年患者中使用骨水泥增强固定治疗转子间骨折。
