Wen Lei, Liu Kun, Chen Ge, Ji Jianhua, Chen Changshun, Chen Zhong
Department of Orthopaedic and Trauma Surgery, Affiliated Hospital of Yunnan University, Kunming, Yunnan Province 650000, China.
Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province 650000, China.
Comput Math Methods Med. 2022 Aug 18;2022:9249920. doi: 10.1155/2022/9249920. eCollection 2022.
Different surgical approaches were systematically evaluated to provide an evidence-based medical rationale for the application and promotion of acetabular fractures in the elderly of China.
Randomized controlled trials (RCT) of different surgical methods in the treatment of elderly acetabular fractures were searched in the PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM). The search time threshold was set from the time the database was created to the current time. Investigators obtained data independently, and the bias risk of each included writing was reviewed using the Cochrane Manual 5.1.0 criterion. The meta data was analyzed using RevMan 5.4 statistical package.
6 RCT articles were included in the end. A total of 445 samples were analyzed by meta. All the six RCT literatures included in this meta-analysis reported the baseline status of patients, only 3 RCT mentioned "random assignment" without any explanation, and the rest did not mention "random" information. The five studies included all gave detailed intervention measures. The number and reasons of blind method and lost follow-up or withdrawal were not described in detail in 6 RCT articles. Through the meta-analysis excellent and good rate between the experimental group and the control group through 6 RCT studies, the heterogeneity test results were chi = 6.11, df = 4, P = 0.19 > 0.05, and I = 35%, without obvious heterogeneity at = 2.68 and = 0.007. These results suggested that the total hip arthroplasty application has the same excellent rate as other surgical treatment methods, indicating that total hip arthroplasty has a significant effect on the treatment of elderly acetabular fractures. Through the meta-analysis hip-joint function score, the heterogeneity test results were chi = 56.16, df = 4, < 0.00001, and = 93%, with obvious heterogeneity. The great difference was discovered in hip function score between total hip arthroplasty and other surgical methods, showing that total hip arthroplasty can greatly improve hip-joint function. Then, the incidence of hip complications between the experimental cases and the control cases was calculated by meta. The heterogeneity test results were chi = 3.17, df = 4, = 0.53 > 0.05, and = 0%, without remarkable heterogeneity at = 3.05 and = 0.002. This demonstrated that a significant difference was observed in the complication incidence, indicating that total hip arthroplasty displayed a lower incidence of hip-joint functional complications.
Total hip arthroplasty has a good prognosis and a low complication rate in the treatment of acetabular fractures in the elderly. However, more studies and longer follow-ups are needed to further validate the findings of this study.
系统评估不同手术方法，为中国老年髋臼骨折的应用和推广提供循证医学依据。
在PubMed、EMBASE、ScienceDirect、Cochrane图书馆、中国知网数据库（CNKI）、中国维普数据库、万方数据库和中国生物医学文献数据库（CBM）中检索不同手术方法治疗老年髋臼骨折的随机对照试验（RCT）。检索时间阈值设定为从数据库创建时间到当前时间。研究人员独立获取数据，并使用Cochrane手册5.1.0标准评估各纳入文献的偏倚风险。使用RevMan 5.4统计软件包进行荟萃分析。
最终纳入6篇RCT文章。共445个样本进行荟萃分析。本荟萃分析纳入的6篇RCT文献均报告了患者的基线状态，只有3篇RCT提到“随机分配”但未作任何解释，其余未提及“随机”信息。纳入的5项研究均给出了详细的干预措施。6篇RCT文章均未详细描述盲法、失访或退出的数量及原因。通过对6项RCT研究中实验组与对照组的优良率进行荟萃分析，异质性检验结果为χ² = 6.11，自由度df = 4，P = 0.19 > 0.05，I² = 35%，在α = 2.68和P = 0.007时无明显异质性。这些结果表明，全髋关节置换术的优良率与其他手术治疗方法相同，提示全髋关节置换术对老年髋臼骨折的治疗有显著效果。通过对髋关节功能评分进行荟萃分析，异质性检验结果为χ² = 56.16，自由度df = 4，P < 0.00001，I² = 93%，存在明显异质性。全髋关节置换术与其他手术方法在髋关节功能评分上差异很大，表明全髋关节置换术可显著改善髋关节功能。然后，通过荟萃分析计算实验组与对照组髋关节并发症的发生率。异质性检验结果为χ² = 3.17，自由度df = 4，P = 0.53 > 0.05，I² = 0%，在α = 3.05和P = 0.002时无显著异质性。这表明在并发症发生率上观察到显著差异，提示全髋关节置换术的髋关节功能并发症发生率较低。
全髋关节置换术治疗老年髋臼骨折预后良好，并发症发生率低。然而，需要更多研究和更长时间的随访来进一步验证本研究结果。
