全髋关节置换后交联聚乙烯和传统聚乙烯髋臼内衬磨损与骨溶解比较的系统评价

发布时间：2018-06-09 03:28

本文选题：关节成形术 + 置换　；参考：《中国组织工程研究》2017年07期

【摘要】：背景:全髋关节置换后远期出现的关节无菌性松动直接影响人工关节使用寿命和患者满意度。导致松动的原因在于人工关节磨损产生的颗粒诱导假体周围骨溶解所致,而髋臼内衬磨损产生的聚乙烯颗粒是主要因素。目的:系统评价全髋关节置换后交联聚乙烯和普通聚乙烯髋臼内衬磨损和骨溶解松动情况的差异。方法:按照Cochrane协作网制订的检索策略进行检索,计算机检索截止至2015年12月Medline、EMbase、中国生物医学文献数据库、相关期刊论文、中文科技期刊全文数据库、万方数据库及Cochrane图书馆(2011年第3期)。手工检索相关的中外骨科杂志和学术会议论文汇编。纳入交联聚乙烯和普通聚乙烯内衬全髋关节置换后聚乙烯磨损情况的随机对照试验11篇,对符合纳入标准的研究用RevM an 5.0软件进行Meta分析。结果与结论:(1)纳入随机对照试验11篇,共952例患者;(2)Meta分析结果显示,术后平均5年交联聚乙烯髋臼内衬线性磨损率显著低于传统聚乙烯髋臼[MD=-0.07,CI(-0.09,-0.05),I~2=93%,P0.000 01],由于异质性很大(I2=93%),行敏感性分析,去掉3个研究后异质性下降[MD=-0.06,95%CI(-0.07,-0.04),I2=39%,P0.000 01];(3)术后平均5年骨溶解松动Meta分析显示,交联聚乙烯内衬组的骨溶解松动率显著低于普通聚乙烯内衬组[RR=0.39,95%CI(0.27,0.57),I2=0%,P0.000 01];(4)结果提示,全髋关节置换交联聚乙烯内衬髋臼较普通聚乙烯更耐磨,近期磨损率更低,磨损碎少,引起骨溶解松动的概率越低。但由于搜集的随机对照试验研究平均随访时间5年(1.8-8.0年),长期随访结果不得而知。鉴于纳入研究在方法学方面的局限性,尚需开展多中心、大样本、高质量的随机对照试验进一步论证交联聚乙烯的疗效和安全性。
[Abstract]:Background: long-term aseptic loosening after total hip arthroplasty has a direct impact on life expectancy and patient satisfaction. The reason of loosening is that the particles produced by artificial joint wear induce osteolysis around the prosthesis, while polyethylene particles produced by acetabular lining wear are the main factors. Objective: to evaluate the differences of acetabular lining wear and osteolysis loosening between crosslinked polyethylene and ordinary polyethylene after total hip arthroplasty. Methods: according to the search strategy formulated by Cochrane Cooperative Network, we searched Medline EMbase, Chinese Biomedical Literature Database, Chinese Journal Full-text Database and Chinese Sci-tech Journal Full-text Database as of December 2015. Wanfang Database and Cochrane Library (No. 3, 2011). Manual retrieval of relevant Chinese and foreign orthopedic journals and papers collected from academic conferences. Eleven randomized controlled trials including cross-linked polyethylene (XLPE) and common polyethylene (PE) lined with total hip joint replacement (THR) were carried out. Meta-analysis was carried out with Revan 5.0 software. Results A total of 952 patients were included in 11 randomized controlled trials. The results of meta-analysis showed that The average linear wear rate of cross-linked polyethylene acetabular lining in 5 years after operation was significantly lower than that of conventional polyethylene acetabular lining. After the removal of 3 studies, the heterogeneity decreased [MD-0.06 ~ 95CI-0.07 ~ (-0.04) I _ (2 / 39) P _ (0.00001)]. Meta-analysis showed that the osteolysis loosening rate of the cross-linked polyethylene lining group was significantly lower than that of the ordinary polyethylene lining group [RR0.3995CI0.270.270.57] P0.0004. The results showed that the osteolysis loosening rate in the cross-linked polyethylene lining group was significantly lower than that in the common polyethylene lining group [RR0.3995CI0.270.270.57] P0.00001]. The acetabular lining of total hip joint replacement crosslinked polyethylene is more wear-resistant than ordinary polyethylene, and the probability of bone dissolution loosening is lower because of lower wear rate and less abrasion in the near future. However, the results of long-term follow-up are unknown because of the average follow-up time of 1. 8-8. 0 years. In view of the methodological limitations of the inclusion study, a multicenter, large sample, and high quality randomized controlled trial is needed to further demonstrate the efficacy and safety of crosslinked polyethylene (XLPE).
【作者单位】：南阳市中心医院/郑州大学附属南阳医院;河南省淅川县人民医院;解放军兰州军区兰州总医院全军骨科中心;兰州大学第二医院骨科;
【基金】：国家自然科学基金面上项目(81371983)~~
【分类号】：R687.4;R318.17

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