Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports.
Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports.
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DOI：
10.1055/s-2005-919113
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发表时间：
2005-05
期刊：
影响因子：
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通讯作者：
Grace L. Lu-Yao;R. Keller;B. Littenberg;J. Wennberg
中科院分区：
文献类型：
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作者：
Grace L. Lu-Yao;R. Keller;B. Littenberg;J. Wennberg
荟萃分析是一种综合多来源数据的技术，我们对106例移位性股骨颈骨折的治疗报告进行了分析。移位性股骨颈骨折初次内固定后两年或更短时间内，33%的患者出现骨不连，16%的患者出现缺血性坏死。内固定后两年内第二次手术的成功率为20%至36%，半关节置换术后为6%至18%（相对风险为2.6%；95%置信区间为1.4至4.6）。关节置换术是内固定后最常见的再手术，约占这些手术的三分之二。其余三分之一的再手术是为了取出植入物或翻修内固定。对于做过半髋关节置换术的患者，最常见的再手术是全髋关节置换术，假体的移除或修复，以及伤口的修复。虽然我们观察到初次半关节置换术后30天的死亡率与初次内固定后的死亡率相比有所增加，但差异不显著（p = 0.22），并且不会持续超过3个月。两组围手术期死亡率的绝对差异很小。关节置换术的前路手术在两个月时的死亡率始终低于后路手术。一些报道显示置换股骨颈骨折的全髋关节置换术有良好的效果；然而，仍然需要随机临床试验来确定这种治疗的价值。
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.