关节置换_____内固定；_关节置换；

内固定与髋关节置换术治疗老年有移位股骨颈骨折的系统评价

http://www.100md.com 《新疆医科大学学报》 2006年第2期

关节置换,,内固定；,关节置换；,股骨颈骨折；,老年；,系统评价,1资料与方法,2结果,3讨论,参考文献:

     摘要: 目的：比较骨折复位内固定与髋关节置换术治疗老年股骨颈骨折的疗效。方法：收集所有的内固定与髋关节置换术治疗老年股骨颈骨折的随机对照试验(RCT)，对其逐个进行质量分析，作系统评价。结果：内固定术较髋关节置换术手术时间短(P<0.05)，手术失血量少(P<0.05)，术后并发症少(P<0.05)，但其再次手术率明显高于髋关节置换术(P<0.05)。结论：内固定术的创伤较小，术后并发症少，但因其术后骨折不愈合和股骨头缺血坏死率较高，其再次手术率明显高于髋关节置换术。

    关键词：内固定；关节置换；股骨颈骨折；老年；系统评价

    Systematic review of internal fixation versus hip arthroplasty for displaced

    femoral neck fractures in the elderly

    ZHAI Sheng, BAI Jingping

    (Department of Orthopedics, Fifth Affiliated Hospital, Xinjiang Medical University, Urumqi 830000, China)

    Abstract: Objective: To compare the effects of internal fixation with that of arthroplasty for displaced femoral neck fractures in the elderly. Methods: All RCTs of internal fixation versus hip arthroplasty for displaced femoral neck fractures in the elderly were identified. Two reviewers assessed the quality of the trials and extracted data independently. Results: Fifteen published trials including a total of 2301 patients were included. Nine studies compared internal fixation with hemiarthroplasty; Four studies compared internal fixation with total hip replacement;Two studies compared internal fixation with hemiarthroplasty or total hip replacement. It was clear that, compared with arthroplasty(hemiarthroplasty or total hip replacement), internal fixation was associated with a shorter length of surgery, lower operative blood loss, and fewer postoperative complications. However, internal fixation was associated with an increased risk of reoperation when compared with arthroplasty because of fracture nonunion and avascular necrosis. Conclusions: Internal fixation is associated with less surgical trauma for the primary operation but fracture healing complications and secondary surgical operations are more prevalent. Because of poor reporting of outcomes, it is not possible to determine if any significant difference in the outcome of hip function do exist. More trials with high quality on methodology are needed. ......

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