全髋关节置换术应用高交联和传统聚乙烯内衬的Meta分析  

Meta-analysis of use of highly cross-linked and conventional polyethylene liners in total hip arthroplasty

作　　者：许可[1] 马信龙[1,2] 李稚君[1] 张华峰[1] 张园[1] 王晨光[1] 

机构地区：[1]天津医科大学总医院骨科,300052 [2]天津医院骨科

出　　处：《中华创伤杂志》2013年第12期1163-1169,共7页Chinese Journal of Trauma

摘　　要：目的评价高交联聚乙烯内衬较传统聚乙烯内衬在全髋关节置换术（total hip arthoplasty，THA）中是否具有优势。方法计算机检索数据库MEDLINE、PubMed、EMBASE、Cochrane图书馆、中国生物医学光盘数据库、中国生物医学文献数据库和维普中文科技期刊数据库中关于高交联和传统聚乙烯内衬在THA的临床随机对照研究（randomized controlled trials，RCTs），并查阅所有检出文献和相关综述的参考文献作为补充资料，截止到2012年4月。采用RevMan5．1软件进行统计分析，高交联组与传统组磨损情况采用均数差评价，骨溶解和翻修手术的发生率采用优势比评价。结果Meta分析结果显示，与对照组相比高交联聚乙烯内衬可以明显降低患者THA术后二维线性磨损率[均数差（mean difference，MD）=-0．08，95％可信区间（confidence interval，CI）（-0．1，0．06），P〈0．05]、三维线性磨损率[MD=-0．15，95％C／（-0．22，0．08），P〈0．05]、容积磨损率[MD=-53．03，95％C／（-84．39，-21．67），P〈0．05]和总磨损量[MD=-0．19，95％C／（-0．23，-0．15），P〈0．05]，明显减少骨溶解的发生率[比值比（oddsratio，OR）=0．23，95％C／（0．13，0．39），P〈0．05]，蠕变量和翻修手术的发生率差异无统计学意义。结论高交联聚乙烯内衬对于初次THA可以明显减少磨损和骨溶解的发生。限于纳入文献的数量和质量，Meta分析结果尚有待于更多的高质量大样本RCTs的长期随访予以证实。Objective To assess whether highly cross-linked polyethylene liners are superior to conventional polyethylene liners in total hip arthroplasty （THA）. Methods Randomized controlled trials （RCTs） of highly cross-linked and conventional polyethylene liners in THA were retrieved from MEDLINE, PubMed, EMBASE, Cochrane Central, CBMdisc, CBM, and VIP. Until April 2012, reference lists of the included articles and related reviews were manually searched as supplements. Meta analysis was performed with RevMan 5.1. Mean difference （MD） was used to assess the linear wear rate in highly cross-linked group versus conventional group. Odds ratio （OR） was used to estimate the osteolysis and revision incidence in the two groups. Results Meta analysis indicated that the two-dimensional linear wear rate [MD = -0.08, 95% CI （ -0.1,0.06）, P 〈0.05] , three-dimensional linear wear rate [MD = -0.15, 95%CI （ -0.22, 0.08）, P 〈0.05], volumetric wear rate [MD = -53.03, 95% CI （ -84.39,-21.67, P〈0.05], total linear wear [MD= -0.19, 95%CI （ -0.23, -0.15）, P〈 0.05], and osteolysis incidence [OR =0.23, 95% CI （0. 13, 0.39）, P 〈0.05] were significantly reduced in highly cross-linked group than in conventional group. There were no statistical differencesConclusions Highly cross-linked polyethylene liners for primrose THA present a low incidence of wear and osteolysis. As the number and quality of the included studies are limited, a long-tern1 follow-up of more large-sample and high-quality RCTs are needed to evidence the outcome.

关 键 词：关节成形术 置换 髋 聚乙烯 META分析 

分 类 号：R687.4[医药卫生—骨科学]