Lu-Yao G L, Keller R B, Littenberg B, Wennberg J E
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755.
J Bone Joint Surg Am. 1994 Jan;76(1):15-25. doi: 10.2106/00004623-199401000-00003.
Methods of meta-analysis, a technique for the combination of data from multiple sources, were applied to analyze 106 reports of the treatment of displaced fractures of the femoral neck. Two years or less after primary internal fixation of a displaced fracture of the femoral neck, a non-union had developed in 33 per cent of the patients and avascular necrosis, in 16 per cent. The rate of performance of a second operation within two years ranged from 20 to 36 per cent after internal fixation and from 6 to 18 per cent after hemiarthroplasty (relative risk, 2.6; 95 per cent confidence interval, 1.4 to 4.6). Conversion to an arthroplasty was the most common reoperation after internal fixation and accounted for about two-thirds of these procedures. The remaining one-third of the reoperations were for removal of the implant or revision of the internal fixation. For the patients who had had a hemiarthroplasty, the most common reoperations were conversion to a total hip replacement, removal or revision of the prosthesis, and débridement of the wound. Although we observed an increase in the rate of mortality at thirty days after primary hemiarthroplasty compared with that after primary internal fixation, the difference was not significant (p = 0.22) and did not persist beyond three months. The absolute difference in perioperative mortality between the two groups was small. An anterior operative approach for arthroplasty consistently was associated with a lower rate of mortality at two months than was a posterior approach. Some reports showed promising results after total hip replacement for displaced fractures of the femoral neck; however, randomized clinical trials are still needed to establish the value of this treatment.
采用荟萃分析方法（一种整合多源数据的技术）对106篇关于股骨颈移位骨折治疗的报告进行分析。股骨颈移位骨折初次内固定术后两年或更短时间内，33%的患者发生了骨不连，16%的患者发生了股骨头缺血性坏死。内固定术后两年内二次手术的发生率为20%至36%，半髋关节置换术后为6%至18%（相对危险度为2.6；95%置信区间为1.4至4.6）。内固定术后最常见的再次手术是转换为关节置换术，约占这些手术的三分之二。其余三分之一的再次手术是为了取出植入物或翻修内固定。对于接受半髋关节置换术的患者，最常见的再次手术是转换为全髋关节置换术、取出或翻修假体以及清创伤口。尽管我们观察到初次半髋关节置换术后30天的死亡率高于初次内固定术后，但差异无统计学意义（p = 0.22），且在三个月后未持续存在。两组围手术期死亡率的绝对差异很小。关节置换术采用前路手术入路时，两个月时的死亡率始终低于后路手术入路。一些报告显示，股骨颈移位骨折全髋关节置换术后取得了有希望的结果；然而，仍需要随机临床试验来确定这种治疗方法的价值。
