【摘要】：目的 :系統(tǒng)評價微創(chuàng)全髖關(guān)節(jié)置換術(shù)與傳統(tǒng)全髖關(guān)節(jié)置換術(shù)治療髖關(guān)節(jié)疾病的療效。方法 :計算機(jī)檢索Pub Med、Cochrane Library、EMbase、Web of Science、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)、相關(guān)期刊論文(CNKI)、萬方期刊全文數(shù)據(jù)庫(Wanfang Data)的微創(chuàng)全髖關(guān)節(jié)置換術(shù)與傳統(tǒng)全髖關(guān)節(jié)置換術(shù)治療髖關(guān)節(jié)疾病的隨機(jī)對照試驗,時間為建庫至2014年6月。按照納入與排除標(biāo)準(zhǔn)獨(dú)立篩選文獻(xiàn)、提取資料,按Cochrane Handbook 5.0推薦的"偏倚風(fēng)險評估"工具對納入研究進(jìn)行方法學(xué)質(zhì)量評價,采用Rev Man 5.3軟件進(jìn)行Meta分析。比較兩組術(shù)后3個月Harris髖關(guān)節(jié)評分、術(shù)后1年Harris髖關(guān)節(jié)評分、術(shù)后6周WOMAC評分、術(shù)后6周Oxford評分、術(shù)后8 h紅細(xì)胞壓積、術(shù)后48 h紅細(xì)胞壓積及血紅蛋白量、術(shù)后髖內(nèi)翻及髖關(guān)節(jié)脫位發(fā)生率和股骨偏心距增加值。結(jié)果 :共納入13個隨機(jī)對照試驗,共1 213例患者(1 284髖),其中微創(chuàng)全髖關(guān)節(jié)置換術(shù)631髖,傳統(tǒng)全髖關(guān)節(jié)置換術(shù)653髖。Meta分析結(jié)果顯示:術(shù)后3個月Harris髖關(guān)節(jié)評分[MD=8.37,95%CI(6.02,10.72)],術(shù)后48 h紅細(xì)胞壓積[MD=0.02,95%CI(0.01,0.03)],術(shù)后48 h血紅蛋白量[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?zhèn)鹘y(tǒng)全髖關(guān)節(jié)置換術(shù)優(yōu)于微創(chuàng)全髖關(guān)節(jié)置換術(shù),差異有統(tǒng)計學(xué)意義;術(shù)后1年Harris髖關(guān)節(jié)評分[MD=3.26,95%CI(-3.25,9.76)],術(shù)后6周WOMAC評分[MD=-0.53,95%CI(-3.67,2.60)],術(shù)后6周Oxford評分[MD=1.34,95%CI(-3.46,6.13)],術(shù)后8 h紅細(xì)胞壓積[MD=-0.01,95%CI(-0.02,0.00)],髖內(nèi)翻發(fā)生率[RR=0.82,95%CI(0.45,1.52)],髖關(guān)節(jié)脫位發(fā)生率[RR=1.40,95%CI(0.48,4.12)]方面兩組差異無統(tǒng)計學(xué)意義。結(jié)論 :傳統(tǒng)全髖關(guān)節(jié)置換術(shù)可帶來更小的創(chuàng)傷和失血,其術(shù)后早期療效優(yōu)于微創(chuàng)全髖關(guān)節(jié)置換術(shù);兩種術(shù)式在術(shù)后并發(fā)癥發(fā)生率方面并無差異。
[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.
【作者單位】： 甘肅中醫(yī)藥大學(xué)臨床醫(yī)學(xué)院;蘭州大學(xué)循證醫(yī)學(xué)中心基礎(chǔ)醫(yī)學(xué)院;蘭州軍區(qū)蘭州總醫(yī)院骨科中心關(guān)節(jié)骨病外科;上海交通大學(xué)附屬第六人民醫(yī)院;
【分類號】：R687.4

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