Hurley Eoghan T, Meyer Alex M, Cabell Grant H, Brown Matthew J, Paul Alexandra V, Reilly Rachel, Olson Stephen A, Pean Christian A, DeBaun Malcolm R
From the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
J Am Acad Orthop Surg. 2024 Oct 1;32(19):e996-e1004. doi: 10.5435/JAAOS-D-23-00564. Epub 2024 May 8.
The purpose of this study was to conduct a meta-analysis of the randomized controlled trials (RCTs) to compare the outcomes after cemented and noncemented hemiarthroplasty for femoral neck fractures.
A literature search of three databases was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing cemented and noncemented hemiarthroplasty for femoral neck fractures were included. Clinical outcomes were compared using Revman, and a P-value < 0.05 was considered to be statistically significant.
Nine RCTs with 3,177 patients were included. Overall, 24.2% of patients treated with a cemented hemiarthroplasty and 28.6% of patients treated with cemented hemiarthroplasty died within 1 year (P = 0.01), but there was no significant difference in perioperative mortality or mortality at 30 days (P > 0.05 for both). A significantly lower rate of periprosthetic fractures with cemented hemiarthroplasty (0.9% versus 4.8%, P < 0.0001) was also noted, but there was no significant difference in the rate of revision surgery, dislocations, or wound infections (P > 0.05). Noncemented hemiarthroplasty resulted in significantly faster surgical times (61.7 versus 69.5 minutes, P = 0.007).
The current level 1 evidence shows that cemented hemiarthroplasty for femoral neck fractures offers improved 1-year mortality rates and less periprosthetic fracture compared with noncemented hemiarthroplasty. Despite the increase in surgical time, cemented hemiarthroplasty offers compelling clinical advantages compared with noncemented hemiarthroplasty for surgical management of displaced femoral neck fractures in the elderly.
Level I; meta-analysis of Level I studies.
本研究的目的是对随机对照试验（RCT）进行荟萃分析，以比较股骨颈骨折行骨水泥型与非骨水泥型半髋关节置换术后的疗效。
根据系统评价和荟萃分析的首选报告项目指南，对三个数据库进行文献检索。纳入比较股骨颈骨折行骨水泥型与非骨水泥型半髋关节置换术的随机对照试验。使用Revman比较临床结局，P值<0.05被认为具有统计学意义。
纳入9项随机对照试验，共3177例患者。总体而言，接受骨水泥型半髋关节置换术治疗的患者中有24.2%在1年内死亡，接受非骨水泥型半髋关节置换术治疗的患者中有28.6%在1年内死亡（P = 0.01），但围手术期死亡率或30天死亡率无显著差异（两者P均>0.05）。还注意到骨水泥型半髋关节置换术的假体周围骨折发生率显著较低（0.9%对4.8%，P < 0.0001），但翻修手术率、脱位率或伤口感染率无显著差异（P > 0.05）。非骨水泥型半髋关节置换术的手术时间明显更短（61.7分钟对69.5分钟，P = 0.007）。
目前的一级证据表明，与非骨水泥型半髋关节置换术相比，股骨颈骨折行骨水泥型半髋关节置换术可提高1年死亡率，减少假体周围骨折。尽管手术时间增加，但与非骨水泥型半髋关节置换术相比，骨水泥型半髋关节置换术在老年移位型股骨颈骨折的手术治疗中具有明显的临床优势。
一级；一级研究的荟萃分析。
