| purpose: With the development of the society, the incidence of hip fracture in the elderly is increasing over year.90% hip fractures were in the people older than 50 years, and it is the most threatening event for the old. There were inconsistent results among different studies about the prognosis of hip fracture in old patients between surgery and non-surgery treatments. So we used evidence based medicine methods to evaluate the mortality rate and complications between surgery and non-surgery treatments in patients with hip fracture in old people, and reviewed the survival benefits in old hip fracture patients between surgery and non-surgery treatments. patients with hip fracture to establish the theoretic and provide a guide for a further improvement of curative effect.Method: We reviewed the risk factors,pathophysiological changes,treatment progress and prognostic factors for elderly hip fracture. Meanwhile, we used systematic review method to include those studies which compared surgery and non-surgery treatments for elderly hip fracture from CNKI, VIP database, Wanfang database, Chinese medical will database, PubMed, EMBASE, web of science, and the Cochrane Library. The outcomes were mortality rate, survival time, hospitalization complications, cause of death, 1, 3, 5 years survival rate. Random effect model meta analysis was conducted by Revman 5 software. At the same time, we researched 121 old patients with hip fracture in our hospital to analyze the difference between surgery and non-surgery treatments in mortality, survival time, complications,survival rate. The patients with femoral intertrochanter fracture were randomly divided into PFNA group(n=46) and DHS group(n=33). The two groups were compared in aspect of general data. The clinical date of surgical trauma, complications and postoperative function of the two groups were compared. Data was analyzed by SPSS 17 software, x ±s method or t test for continuous data and chi square test or χ2 for discontinuous data. KM method was used to draw the survival curve,and Cox regression method was used to analyze the effect of different factors.Result:A total of 1864 patients. O f these patients,1259 patients were treated with surgery, and 605 patients were treated with non operative treatment. Surgical treatment can significantly reduce mortality(O R 0.08, 95%CI0.04 0.15), incidence of pulmonary infection(OR 0.27,95% CI 0.12 0.63), the incidence of urinary tract infection(O R 0.98,95% CI 0.21 4.55), the incidence of cerebrovascular accident(OR 0.16,95% CI 0.66 to 0.04), the incidence of heart failure(OR 0.18,95% CI 0.06 0.52). In 121 patients, 95 patients were treated with surgery, 26 patients were treated conservatively, the average survival time for patients with surgery was 40.92 months(SD 17.72 months),the average survival time for patients with non-surgery treatments was 17.5 months(9.38 months), and the t test showed significant difference between the two groups(t=9.05, p<0.05). There were 26 cases of death in the surgical group, 25 cases in the non operation group, and there was significant difference in the death of cerebral vascular accident and pulmonary infection. The patients with femoral intertrochanter fracture were followed up ranged from 12 to 36 months. Compared with DHS group,PFNA group had better outcome, there was statistically significant in the operation time, blood loss, postoperative time in bed and fracture healing(P<0.05). There was no significant difference in the functional recovery of hip between two groups(P>0.05).Conclusion: The surgical treatment can significantly reduce the mortality in elderly patients with hip fracture, the incidence of pulmonary infection, cerebrovascular accident,the incidence of heart failure,but did not reduce the incidence of urinary tract infections. Retrospective study showed that the survival of the patients with surgical treatment has obvious survival advantages compared with non-surgical treatment. surgery can effectively prolong the survival time and reduce the case fatality rate. At the same time,Compared with DHS fixation, the PFNA has many advantages,hip functional recovery is satisfied, fewer comp lications, which has a greater improvement of life quality of aged patients after operation. But there was a potential bias in the study,which needs to be overcome in the future. |
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