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1、新疆医科大学学报JOURNALOFXINJIANGMEDICALUNIVERSITY2006Feb.,29(2)137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132翟生,白靖平(新疆医科大学1第五附属医院骨科,2附属肿瘤医院骨科,新疆乌鲁木齐830000)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
2、(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;系统评价中图分类号:R687.32;R683.42文献标识码:A文章编号:100925551(2006)0220137205Systematicreviewofinternalfixationversushiparthroplastyfordisplacedfemoralneckfracturesintheelderl
3、yZHAISheng,BAIJing2ping(DepartmentofOrthopedics,FifthAffiliatedHospital,XinjiangMedicalUniversity,Urumqi830000,China)Abstract:Objective:Tocomparetheeffectsofinternalfixationwiththatofarthroplastyfordisplacedfem2oralneckfracturesintheelderly.Methods:AllRCTsofinternalfixationve
4、rsushiparthroplastyfordis2placedfemoralneckfracturesintheelderlywereidentified.Tworeviewersassessedthequalityofthetrialsandextracteddataindependently.Results:Fifteenpublishedtrialsincludingatotalof2301patientswereincluded.Ninestudiescomparedinternalfixationwithhemiarthroplast
5、y;Fourstudiescomparedinternalfixationwithtotalhipreplacement;Twostudiescomparedinternalfixationwithhemiarthroplastyortotalhipreplacement.Itwasclearthat,comparedwitharthroplasty(hemiarthroplastyortotalhipreplace2ment),internalfixationwasassociatedwithashorterlengthofsurgery,lo
6、weroperativebloodloss,andfewerpostoperativecomplications.However,internalfixationwasassociatedwithanincreasedriskofre2operationwhencomparedwitharthroplastybecauseoffracturenon2unionandavascularnecrosis.Conclu2sions:Internalfixationisassociatedwithlesssurgicaltraumafortheprima
7、ryoperationbutfracturehealingcomplicationsandsecondarysurgicaloperationsaremoreprevalent.Becauseofpoorreportingofout2comes,itisnotpossibletodetermineifanysignificantdifferenceintheoutcomeofhipfunctiondoexist.Moretrialswithhighqualityonmethodologyareneeded.Keywords:internalfix
8、ation;arthroplasty;femoralneckfractures;elderly;systematicreview股骨颈骨
