A comparison of hemiarthroplasty and internal fixation for treating unstable intertrochanteric hip fractures in elderly patients: a systematic review
WANG Guo-sheng;WEI Ning-bo;CAO Ming-yu;The Joint Surgery,The Sixth Affiliated Hospital of Xinjiang Medical University;
[Objective]To compare the effects of hemiprosthesis arthroplasty with those of internal fixation for treating unstable intertrochanteric hip fractures in elderly patients. [Method]We searched 5 electronic databases,namely CNKI( 1960-2013. 4),WanFang( 1998- 2013. 4),VIP( 1989- 2013. 4),CBM,and CHAOXING for randomized controlled and quasi- randomized controlled trials comparing hemiarthroplasty and internal fixation for treating unstable intertrochanteric hip fractures in elderly patients. In addition,we searched domestic literature published in orthopedic journals and related magazines,including Chinese Journal of Joint Surgery,Chinese Journal of Trauma,Chinese Journal of Orthopaedics,Orthopaedic Journal of China, Chinese General Practice,Chinese Journal of Bone and Joint Injury etc. for the past five years. The Rev Man 5. 0,provided by the Cochrane Collaboration,was used for management and analysis. [Result]Thirty-five randomized controlled and quasi-randomized controlled trials,involving 2739 patients,were included in this study. Based on an evaluation of the quality of the included studies,it was determined that 27 studies were of grade B and 8 were of grade C. In comparison with the traditional internal fixation group,the hemiarthroplasty group demonstrated earlier weight-bearing activity after mobilization( MD =- 32. 66, 95% confidence interval [CI][- 40. 16,- 25. 15],P 0. 05),fewer complications( RR = 0. 47,95% CI[0. 37,0. 60],P 0. 05),and a higher rate of postoperative excellence( RR = 1. 18,95% CI[1. 07,1. 31],P = 0. 001 or 0. 05). However,there was no significant difference between the 2 groups with respect to operative time and blood loss. [Conclusion]In comparison with conventional internal fixation,hemiarthroplasty enables earlier weight-bearing activity after mobilization,fewer complications,and the advantage of a higher quality in the treatment of elderly patients with unstable intertrochanteric fractures,andshould therefore be preferred. However,this systematic review had some limitations and biases,which may cause decreased reliability of the results. This review also needs to be more rigorous,with a larger,multi-center sample volume; and the right randomization,principles,blinding procedures,allocation con-cealment,and review of other literature if it is to be used for further demonstration.
【CateGory Index】： R687.3