背景:存在用于股骨颈骨折(FNF)治疗的多种半髋关节置换术(HA)方法。然而,对于一种方法对术后结局的优越性尚无共识.本研究评估了随机对照试验(RCT)比较后路(PA)的结果,直接横向进近(DLA),前外侧入路(ALA),和直接前入路(DAA)中的HA用于FNF。
方法:PubMed,Ovid/MEDLINE,Scopus,Cochrane中央控制试验登记处,和Cochrane系统评价数据库在2024年2月进行了查询。对符合条件的前瞻性RCT进行的频率模型网络荟萃分析使用P分数比较了方法之间的结果。
结果:在检索到的1,481项研究中,11项RCT,总计1,513名通过PA接受HA的FNF患者(n=446;29.5%),DLA(n=481;31.8%),ALA(n=296;19.6%),或DAA(n=290;19.2%),中位(四分位距)随访6个月(4.5-12.0),纳入荟萃分析.DAA与手术持续时间增加相关(平均差异[MD],1.89分钟;95%CI,0.08至3.69分钟;p<0.001)与PA相比,而与PA相比,ALA与统计学上更大的失血量相关(MD,5.81mL;95%CI,4.11至7.50mL;p<0.001)。骨折的发生率没有差异,位错,感染,并发症,修订版,方法中的1年死亡率也没有。在最近的随访中,髋关节和疼痛评分改善也没有差异,尽管具有高度异质性(I2=85.7%和94.2%,分别)。
结论:这项研究发现疼痛改善没有临床差异,函数,FNF的HA方法的修订结果和手术特征也没有,每种方法的不良事件特征相似.尽管随机证据有限,这些研究结果表明,所有方法的短期疗效和安全性具有可比性.
方法:治疗,有关证据级别的完整描述,请参阅作者说明。
BACKGROUND: Multiple
hemiarthroplasty (HA) approaches exist for femoral neck fracture (FNF) treatment. However, there is no consensus on the superiority of one approach for postoperative outcomes. This study assessed outcomes among randomized controlled trials (RCTs) comparing the posterior approach (PA), direct lateral approach (DLA), anterolateral approach (ALA), and the direct anterior approach (DAA) in HA for FNF.
METHODS: PubMed, Ovid/MEDLINE, Scopus, Cochrane Central Registry of Controlled Trials, and Cochrane Database of Systematic Reviews were queried in February 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared outcomes among approaches using P-scores.
RESULTS: Of 1,481 retrieved studies, 11 RCTs totaling 1,513 FNF patients who underwent HA through a PA (n = 446; 29.5%), DLA (n = 481; 31.8%), ALA (n = 296; 19.6%), or DAA (n = 290; 19.2%) with median (interquartile range) follow-up of 6 (4.5-12.0) months were included for meta-analysis. DAA was associated with statistically increased operative duration (mean difference [MD], 1.89 minutes; 95% CI, 0.08 to 3.69 minutes; p < 0.001) compared with a PA, whereas an ALA was associated with statistically greater blood loss compared with a PA (MD, 5.81 mL; 95% CI, 4.11 to 7.50 mL; p < 0.001). There were no differences in the incidence of fracture, dislocation, infection, complications, revision, nor 1-year mortality among approaches. There were also no differences in hip nor pain score improvement at latest follow-up, although with high heterogeneity (I2 = 85.7% and 94.2%, respectively).
CONCLUSIONS: This study found no clinical difference in improvement in pain, function, nor in revision outcomes and operative characteristics among HA approaches for FNF, and each approach had a similar adverse event profile. Despite limited randomized evidence, these findings suggest comparable short-term efficacy and safety of all approaches.
METHODS: Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.