陶瓷-陶瓷界面和陶瓷-聚乙烯界面在全髋关节置换中疗效和安全性的Meta分析  

Ceramic-on-ceramic versus ceramic-on-polyethylene bearing surfaces in total hip arthroplasty:a meta analysis of efficacy and safety

作　　者：Mohammed Alezzi Mohammed 方淑莺[1] 廖威明[1] 赵潇艺 罗家月 张紫机[1] 

机构地区：[1]中山大学附属第一医院关节外科,广东省广州市510080 [2]中山大学医学院,广东省广州市510080

出　　处：《中国组织工程研究》2016年第4期595-601,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:陶瓷-陶瓷界面因低磨损而被重视,但其也伴随着异响和破裂的风险。因此目前对陶瓷-陶瓷界面和陶瓷-聚乙烯界面在全髋关节置换中的应用仍存在较多争议。目的:通过Meta分析评价陶瓷-陶瓷界面和陶瓷-聚乙烯界面在全髋关节置换中的疗效和安全性。方法:计算机检索Pub Med/Medline、Embase、Web of Science、Cochrane协作网数据库、中国生物医学文献数据库(CBMdisc)和中文期刊全文数据库(CNKI)。全面收集2015年1月前发表的比较陶瓷-陶瓷界面和陶瓷-聚乙烯界面全髋关节置换疗效和安全性的随机对照试验,并追溯纳入研究的参考文献。严格按照纳入与排除标准筛选文献、提取资料并进行质量评价,采用Rev Man 5.2进行Meta分析。结果与结论:共9个临床随机对照试验纳入研究,其中陶瓷-陶瓷界面人工关节1 231髋,陶瓷-聚乙烯界面人工关节932髋。Meta分析结果发现,陶瓷-陶瓷和陶瓷-聚乙烯人工关节均能明显改善关节功能;陶瓷-陶瓷人工关节有着较高的术中、术后假体破裂率和异响发生率,陶瓷-聚乙烯人工关节则假体磨损速度更快;但在短-中期随访中,关节脱位、骨溶解、假体松动等置换相关并发症和各原因导致的假体翻修率在两组间差异并无显著性意义。提示陶瓷-陶瓷和陶瓷-聚乙烯全髋关节假体的修复效果和安全性在短-中期随访中并无明显差异,但其二者远期效果仍有待观察。BACKGROUND： Greatly importance has been attached to ceramic-on-ceramic bearing surface due to its excellent wear resistance. But the risks of squeaking and ceramic fracture also go with it. Up till now, the choicebetween ceramic-on-ceramic and ceramic-on-polyethylene bearing surfaces in primary total hip arthroplasty remains controversial. OBJECTIVE： To compare the clinical outcomes and safety between ceramic-on-ceramic versus ceramic-on-polyethylene bearing surfaces in total hip arthroplasty based on meta analysis. METHODS： We electronically searched databases including Pub Med/Medline, Embase, Web of Science, Cochrane Collaboration database, Chinese Biomedical Literature Database（CBMdisc） and China National Knowledge Internet for randomized controlled trials on the comparison between ceramic-on-ceramic versus ceramic-on-polyethylene bearing surfaces in total hip arthroplasty from inception to January 2015. References of the included studies were also retrieved. Investigators severely selected the studies, extracted data and assessed the quality according to the inclusion and exclusion criteria. Then, meta-analysis was performed using Rev Man 5.2 software. RESULTS AND CONCLUSION： Nine randomized controlled trials were included, involving 1 231 hips with ceramic-on-ceramic prosthesis and 932 hips with ceramic-on-polyethylene prosthesis. Meta analysis showed that both bearing surfaces achieved satisfied function recovery. But ceramic-on-ceramic had significantly increased risks of squeaking and ceramic fracture, meanwhile ceramic-on-polyethylene showed significantly higher wear rate. There were no significant differences in intra- or post-operative dislocation, osteolysis and other complications and prosthesis failure with any reason between two bearing surfaces. These results suggest that during the short- to mid-term follow-up period, no sufficient evidence can tell that ceramic-on-ceramic was obviously super than ceramic-on-polyethylene. Long-term follow-up is required for further evaluation.

关 键 词：关节成形术 置换 髋 假体植入 META分析 组织工程 骨科植入物 人工假体 陶瓷-陶瓷界面 陶瓷-聚乙烯界面 全髋关节置换 

分 类 号：R318[医药卫生—生物医学工程]