文献类型：期刊文献

中文题名：微创与传统全髋关节置换术临床疗效对比的系统评价

英文题名：Comparison of clinical efficacy between minimally invasive total hip arthroplasty and traditional total hip arthroplasty:a systematic review

作者：王荣[1];李秀霞[2];高明暄[3];汪泽皓[4];于利明[1];李旭升[3]

第一作者：王荣

机构：[1]甘肃中医药大学临床医学院,甘肃兰州730000;[2]兰州大学循证医学中心基础医学院,甘肃兰州730000;[3]兰州军区兰州总医院骨科中心关节骨病外科,甘肃兰州730050;[4]上海交通大学附属第六人民医院,上海200000

第一机构：甘肃中医药大学临床医学院

年份：2016

卷号：29

期号：2

起止页码：172

中文期刊名：中国骨伤

外文期刊名：China Journal of Orthopaedics and Traumatology

收录：CSTPCD;;Scopus;PubMed

语种：中文

中文关键词：关节成形术,置换,髋;髋关节;系统评价;随机对照试验

外文关键词：Arthroplasty replacement; hip; Hip joint; Systematic review; Randomized controlled trial

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)、中国期刊全文数据库(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。
Objective：To systematically review the effectiveness of minimally invasive total hip arthroplasty（MIS-THA）versus traditional total hip arthroplasty（THA） in patients with hip diseases. Methods：Through a method of combining Free words and keywords,we searched databases including Pub Med,The Cochrane Library,EMbase,Web of Science,CBM,CNKI and Wanfang Data for randomized controlled trials（RCTs） on the comparison between MIS-THA and THA for hip disease from inception to June,2014. Two reviewers independently screened literatures according to the inclusion and exclusion criteria,extracted data and assessed the quality of the included studies according to the ＂bias risk assessment＂ tool recommended by Cochrane Handbook 5.0 for Systematic Reviews. Then,meta analysis was performed using Rev Man 5.3 software. Results：Thirteen RCTs involving 1 213 cases of surgeries and total 1 284 hips（MIS-THA：n=631;THA：n=653） were identified. The results of meta analysis showed that statistically significant differences were found in Harris hip score on the 3rd month after operation [MD=8.37,95%CI（6.02,10.72）],Hematocrit [MD=0.02,95%CI（0.01,0.03）] and Hemoglobin [MD=0.50,95%CI（0.16,0.85）] at the 48 th hour after operation,changed value of femoral offset [MD=0.30,95%CI（0.04,0.56）] between two groups. In the change value of femoral offset,THA was better than MIS-THA; There were no statistically significant differences between two groups in Harris hip score at 1st year after operation [MD=3.26,95%CI（-3.25,9.76）],WOMAC score [MD=-0.53,95%CI（-3.67,2.60）] and Oxford score [MD=1.34,95%CI（-3.46,6.13）] at the 6th week after operation,Hematocrit at the 8th hour after operation[MD=-0.01,95%CI（-0.02,0.00）],the incidence of hip varus[RR=0.82,95%CI（0.45,1.52）] and dislocation [RR=1.40,95%CI（0.48,4.12）]. Conclusion：THA brings less trauma,less hemorrhage and better early clinical outcome compared with MIS-THA,but the difference of the complication rates between the two groups is similar.