微创与传统全髋关节置换术临床疗效对比的系统评价

发布时间：2019-06-22 08:26

【摘要】：目的 :系统评价微创全髋关节置换术与传统全髋关节置换术治疗髋关节疾病的疗效。方法 :计算机检索Pub Med、Cochrane Library、EMbase、Web of Science、中国生物医学文献数据库(CBM)、相关期刊论文(CNKI)、万方期刊全文数据库(Wanfang Data)的微创全髋关节置换术与传统全髋关节置换术治疗髋关节疾病的随机对照试验,时间为建库至2014年6月。按照纳入与排除标准独立筛选文献、提取资料,按Cochrane Handbook 5.0推荐的"偏倚风险评估"工具对纳入研究进行方法学质量评价,采用Rev Man 5.3软件进行Meta分析。比较两组术后3个月Harris髋关节评分、术后1年Harris髋关节评分、术后6周WOMAC评分、术后6周Oxford评分、术后8 h红细胞压积、术后48 h红细胞压积及血红蛋白量、术后髋内翻及髋关节脱位发生率和股骨偏心距增加值。结果 :共纳入13个随机对照试验,共1 213例患者(1 284髋),其中微创全髋关节置换术631髋,传统全髋关节置换术653髋。Meta分析结果显示:术后3个月Harris髋关节评分[MD=8.37,95%CI(6.02,10.72)],术后48 h红细胞压积[MD=0.02,95%CI(0.01,0.03)],术后48 h血红蛋白量[MD=0.50,95%CI(0.16,0.85)],改善股骨偏心距[MD=0.30,95%CI(0.04,0.56)]方面传统全髋关节置换术优于微创全髋关节置换术,差异有统计学意义;术后1年Harris髋关节评分[MD=3.26,95%CI(-3.25,9.76)],术后6周WOMAC评分[MD=-0.53,95%CI(-3.67,2.60)],术后6周Oxford评分[MD=1.34,95%CI(-3.46,6.13)],术后8 h红细胞压积[MD=-0.01,95%CI(-0.02,0.00)],髋内翻发生率[RR=0.82,95%CI(0.45,1.52)],髋关节脱位发生率[RR=1.40,95%CI(0.48,4.12)]方面两组差异无统计学意义。结论 :传统全髋关节置换术可带来更小的创伤和失血,其术后早期疗效优于微创全髋关节置换术;两种术式在术后并发症发生率方面并无差异。
[Abstract]:Objective: to evaluate the efficacy of minimally invasive total hip arthroplasty and traditional total hip arthroplasty in the treatment of hip joint diseases. Methods: a randomized controlled trial of minimally invasive total hip arthroplasty and traditional total hip arthroplasty (Wanfang Data) was conducted in Pub Med,Cochrane Library,EMbase,Web of Science, Chinese Biomedical Literature Database (CBM), Chinese Journal full-text Database (CNKI), and traditional total hip arthroplasty (THR) for the treatment of hip joint diseases from June 2014 to June 2014. According to the inclusion and exclusion criteria, the literature was screened independently, the data were extracted, the methodological quality of the inclusion study was evaluated according to the "bias risk assessment" tool recommended by Cochrane Handbook 5.0, and the Meta analysis was carried out by using Rev Man 5.3 software. The Harris hip score at 3 months after operation, Harris hip score at 1 year, WOMAC score at 6 weeks after operation, Oxford score at 6 weeks after operation, hematocrit at 8 hours after operation, hematocrit and hemoglobin content at 48 hours after operation, the incidence of hip varus and dislocation of hip joint and the increased value of femoral eccentricity were compared between the two groups. Results: a total of 13 randomized controlled trials were conducted in 13 patients, including 631 hips with minimally invasive total hip arthroplasty and 653 hips with traditional total hip arthroplasty. Meta-analysis showed that Harris hip joint score [MD=8.37,95%CI (6.02, 10.72)] and hematocrit at 48 hours after operation [MD=0.02,95%CI (0.01, 0.03, respectively]) were included in 13 randomized controlled trials, including 653 hips with minimally invasive total hip arthroarthrosis and 653 hips with traditional total hip arthroarthrosis. The results of meta-analysis showed that HCT hip score [MD=0.02,95%CI (6.02, 10.72)] at 48 hours after operation. 48 hours after operation, the hemoglobin content [MD=0.50,95%CI (0.16, 0.85)] and the improvement of femoral eccentricity [MD=0.30,95%CI (0.04, 0.56)] were significantly better than those of minimally invasive total hip arthroplasty. One year after operation, Harris hip score [MD=3.26,95%CI (- 3.25, 9.76)], WOMAC score [MD=-0.53,95%CI (- 3.67, 2.60)], Oxford score [MD=1.34,95%CI (- 3.46, 6.13)] at 6 weeks after operation, hematocrit [MD=-0.01,95%CI (- 0.02, 0.00)] at 8 hours after operation, incidence of hip varus [RR=0.82,95%CI (0.45,1.52)]. There was no significant difference in the incidence of dislocation of hip joint between the two groups [RR=1.40,95%CI (0.48, 4.12)]. Conclusion: traditional total hip arthroplasty can bring less trauma and blood loss, and its early postoperative curative effect is better than that of minimally invasive total hip arthroplasty, and there is no difference in the incidence of postoperative complications between the two methods.
【作者单位】：甘肃中医药大学临床医学院;兰州大学循证医学中心基础医学院;兰州军区兰州总医院骨科中心关节骨病外科;上海交通大学附属第六人民医院;
【分类号】：R687.4

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