Queen Alexandra Hospital, Portsmouth, UK.
Salisbury District Hospital, Salisbury, UK.
Hip Int. 2023 Jul;33(4):752-761. doi: 10.1177/11207000221112579. Epub 2022 Jul 17.
Intertrochanteric fractures are predominantly treated by dynamic hip screw (DHS) fixation. However, recent evidence has found acceptable clinical results following hemiarthroplasty for these fractures. Thus, a systematic review was conducted to compare hemiarthroplasty with DHS fixation for intertrochanteric fractures.
A computerised search was performed, using the databases Medline, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials, with supplementation from Google Scholar and appropriate reference lists. Studies with comparative data comparing clinical outcomes of hemiarthroplasty versus DHS fixation were included. Data were extracted and quality assessment of the papers performed by 2 reviewers.
320 articles were independently reviewed by the investigators. A total of 10 studies met the inclusion criteria, comprising 2 randomised controlled trials and 8 cohort designs. 7 of the studies assessed unstable fracture patterns. There was no difference in operating time (SMD -1.169 min; 95% CI, -0.657 to 0.689) or blood transfusion volume (SMD-0.110 units; 95% CI, -0.520 to 0.891) between modalities. There was also no difference in length of stay (SMD -0.778 days; 95% CI, -0.606 to 0.336), mortality (RR 0.942; 95% CI, 0.749-1.183) or major complications. Hemiarthroplasty conferred significantly better Harris Hip Scores at 12 months (SMD 12.3; 95% CI, 0.0135-2.789) and allowed earlier weight-bearing than DHS fixation.
Qualitative and quantitative compilation of the included studies demonstrates hemiarthroplasty to result in better functional scores and a quicker time to weight-bearing than DHS fixation for intertrochanteric fractures. Results are comparable for other major parameters, including operative time, length of stay and mortality. Thus, hemiarthroplasty is a suitable alternative to DHS fixation for unstable intertrochanteric fractures in elderly patients.
股骨转子间骨折主要采用动力髋螺钉（DHS）固定治疗。然而，最近的证据表明，对于这些骨折，半髋关节置换术也可获得可接受的临床效果。因此，进行了一项系统评价，比较了半髋关节置换术与 DHS 固定治疗股骨转子间骨折的效果。
使用 Medline、EMBASE、CINAHL 和 Cochrane 对照试验中心注册数据库进行计算机检索，并通过 Google Scholar 和适当的参考文献列表进行补充。纳入比较半髋关节置换术与 DHS 固定治疗临床效果的研究。由 2 名评审员提取数据并对论文进行质量评估。
研究人员独立审查了 320 篇文章。共有 10 项研究符合纳入标准，包括 2 项随机对照试验和 8 项队列设计研究。其中 7 项研究评估了不稳定的骨折模式。两种治疗方式在手术时间（SMD-1.169 分钟；95%CI，-0.657 至 0.689）或输血量（SMD-0.110 单位；95%CI，-0.520 至 0.891）方面无差异。两种治疗方式在住院时间（SMD-0.778 天；95%CI，-0.606 至 0.336）、死亡率（RR 0.942；95%CI，0.749 至 1.183）或主要并发症方面也无差异。半髋关节置换术在 12 个月时的 Harris 髋关节评分显著更高（SMD 12.3；95%CI，0.0135 至 2.789），并允许比 DHS 固定更早负重。
纳入研究的定性和定量综合表明，与 DHS 固定相比，半髋关节置换术治疗股骨转子间骨折可获得更好的功能评分和更快的负重时间。在其他主要参数（包括手术时间、住院时间和死亡率）方面，结果相当。因此，对于老年不稳定股骨转子间骨折患者，半髋关节置换术是 DHS 固定的一种合适替代方法。
