直接前入路与后方入路对全髋关节置换术疗效及安全性影响的系统评价及meta分析

发布时间：2018-06-06 22:46

本文选题：手术入路 + 直接前入路　；参考：《中华骨与关节外科杂志》2016年02期

【摘要】：背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影响的对照试验,按照既定的纳入、排除标准检出文献,严格评价纳入研究的方法学质量并提取数据,采用Rev Man 5.2软件对可以合并分析的指标进行meta分析,对不能合并的指标采用描述性分析。结果:纳入文献11篇,共入选患者1612例,其中DAA组817例,PA组795例。DAA组患者术后需使用助行设备的时间明显短于PA组(WMD=-11.05,95%CI:-17.79~-4.31,P=0.001)。描述性分析发现DAA在术后早期功能恢复以及活动能力上优于PA。两组术中及术后1年的并发症发生率(OR=1.48,95%CI:0.69~3.20,P=0.32)、术中骨折发生率(OR=1.31,95%CI:0.50~3.45,P=0.58)、术后脱位发生率(OR=0.34,95%CI:0.09~1.28],P=0.11)、异位骨化发生率(OR=1.01,95%CI:0.26~3.94,P=0.99)、腹股沟区疼痛发生率(OR=2.73,95%CI:0.62~12.06],P=0.19)均无统计学差异。而且两组的手术时间(WMD=10.25,95%CI:-6.33~26.83],P=0.23)、住院时间(WMD=-0.34,95%CI:-0.76~0.07],P=0.10)、Lewinnek安全区内髋臼假体的数量(OR=2.08,95%CI:0.65~6.72,P=0.22)也无统计学差异。同时,DAA具有预防术后脱位的潜在优势,DAA术中使用X线透视会避免出现明显异常的髋臼假体位置。结论:在熟练掌握DAA THA技术的前提下,DAA是具有一定优势的手术入路。
[Abstract]:Background: the efficacy and safety of total hip replacement (THA) by direct anterior approach (DAA) is not clear. Objective: To evaluate the effect and safety of THA after learning through the learning curve (PA) through systematic evaluation and meta analysis. Methods: to retrieve the efficacy and safety of DAA and PA on THA in each database. The influence of the control test, according to the established inclusion, the exclusion criteria of the literature, strict evaluation of the quality of the methodology included in the study and extraction of data, Rev Man 5.2 software for the combined analysis of the index meta analysis, the indicators can not be merged with descriptive analysis. Results: included in the literature 11, a total of 1612 cases of patients, of which DA 817 cases in group A and 795 cases of group.DAA in group PA were significantly shorter than group PA (WMD=-11.05,95%CI:-17.79~-4.31, P=0.001) after operation. The descriptive analysis showed that DAA was superior to PA. two during operation and 1 years of postoperative complications (OR=1.48,95%CI:0.69~3.20, P=0.32), and intraoperative bone. The incidence of OR=1.31,95%CI:0.50~3.45 (P=0.58), the incidence of postoperative dislocation (OR=0.34,95%CI:0.09~1.28], P=0.11), the incidence of heterotopic ossification (OR=1.01,95%CI:0.26~3.94, P=0.99), the incidence of pain in the inguinal region (OR=2.73,95%CI:0.62~12.06], P=0.19), and the two groups of operation time (WMD=10.25,95%CI:-6.33~26.83], P=0.2). 3), the time of hospitalization (WMD=-0.34,95%CI:-0.76~0.07], P=0.10), the number of acetabular prostheses in the Lewinnek safety zone (OR=2.08,95%CI:0.65~6.72, P=0.22) also has no statistical difference. At the same time, DAA has the potential advantage of preventing post operation dislocation. The use of X ray fluoroscopy in DAA can avoid the obvious abnormal acetabular prosthesis position. Conclusion: proficiency in DAA TH Under the premise of A technology, DAA is a surgical approach with certain advantages.
【作者单位】：北京大学中日友好临床医学院;中日友好医院骨关节外科;
【分类号】：R687.4

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