Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain.
Universidad de La Laguna, Tenerife, Spain.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):87-106. doi: 10.1007/s00068-022-02032-8. Epub 2022 Jul 5.
Several studies comparing osteosynthesis and stem revision in Vancouver B2 (VB2) periprosthetic hip fractures (PPHF) have been published. This work aims to be the first systematic review and meta-analysis to include only studies involving statistical comparison between the two techniques.
MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to October 2021 for studies involving a comparison between VB2 treated by osteosynthesis versus revision arthroplasty. The effect size (ES) was calculated using Cohen´s d index.
From 17 published studies selected, a total of 856 patients were recruited (363 osteosynthesis / 493 revision arthroplasty). The pooled ES estimates for the Parker mobility score were 1.03 (95% CI, 0.22-1.84; I2 = 87.7%) for ORIF surgery, and 0.54 (95% CI, - 0.10-1.17; I2 = 83%) for revision surgery. The pooled ES estimates for the operative time, reintervention, complications, hospital stay and needing for blood transfusion were significant lower in ORIF than in revision surgery. There were no differences in first-year mortality between groups. There was a higher proportion of ASA > 3 patients in the ORIF group.
Osteosynthesis versus revision arthroplasty has a shorter operative time, less need for blood transfusion, fewer complications and reoperation rate and shorter hospital stay. Nonetheless, similar results were found for functional tests and first-year mortality. These results support the use of osteosynthesis in selected patients (low functional demand, multiple comorbidities, and high anesthetic risk).
III.
已经发表了几项比较温哥华 B2（VB2）假体周围髋部骨折（PPHF）内固定与翻修的研究。本研究旨在首次进行系统评价和荟萃分析，仅纳入涉及两种技术间统计学比较的研究。
从建库到 2021 年 10 月，我们系统性地检索了 MEDLINE、EMBASE、Cochrane 图书馆和 Web of Science 数据库，以纳入比较 VB2 经内固定与翻修关节成形术治疗的研究。使用 Cohen's d 指数计算效应量（ES）。
从入选的 17 项已发表研究中，共纳入 856 例患者（363 例内固定/493 例翻修）。ORIF 手术和翻修手术的 Parker 活动评分的合并 ES 估计值分别为 1.03（95%CI，0.22-1.84；I2=87.7%）和 0.54（95%CI，-0.10-1.17；I2=83%）。ORIF 组的手术时间、再干预、并发症、住院时间和输血需求的合并 ES 估计值明显低于翻修组。两组间的 1 年死亡率无差异。ORIF 组中 ASA>3 的患者比例更高。
与翻修关节成形术相比，内固定术具有手术时间更短、输血需求更少、并发症和再手术率更低、住院时间更短的优势。然而，在功能测试和 1 年死亡率方面也有相似的结果。这些结果支持在特定患者（低功能需求、多种合并症和高麻醉风险）中选择内固定术。
III 级。
