直接前入路与后方入路对全髋关节置换术疗效及安全性影响的系统评价及meta分析  

A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

作　　者：刘新光[1] 王卫国[2] 张念非[2] 郭万首[1,2] 

机构地区：[1]北京大学中日友好临床医学院,北京100029 [2]中日友好医院骨关节外科,北京100029

出　　处：《中国骨与关节外科》2016年第2期128-134,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:经直接前入路(DAA)行全髋关节置换术(THA)的疗效及安全性尚不明确。目的:应用系统评价及meta分析的方法评价度过学习曲线后DAA和后方入路(PA)对THA疗效及安全性的影响。方法:计算机检索各数据库内关于DAA与PA对THA疗效及安全性影响的对照试验,按照既定的纳入、排除标准检出文献,严格评价纳入研究的方法学质量并提取数据,采用Rev Man 5.2软件对可以合并分析的指标进行meta分析,对不能合并的指标采用描述性分析。结果:纳入文献11篇,共入选患者1612例,其中DAA组817例,PA组795例。DAA组患者术后需使用助行设备的时间明显短于PA组(WMD=-11.05,95%CI:-17.79^-4.31,P=0.001)。描述性分析发现DAA在术后早期功能恢复以及活动能力上优于PA。两组术中及术后1年的并发症发生率(OR=1.48,95%CI:0.69~3.20,P=0.32)、术中骨折发生率(OR=1.31,95%CI:0.50~3.45,P=0.58)、术后脱位发生率(OR=0.34,95%CI:0.09~1.28],P=0.11)、异位骨化发生率(OR=1.01,95%CI:0.26~3.94,P=0.99)、腹股沟区疼痛发生率(OR=2.73,95%CI:0.62~12.06],P=0.19)均无统计学差异。而且两组的手术时间(WMD=10.25,95%CI:-6.33~26.83],P=0.23)、住院时间(WMD=-0.34,95%CI:-0.76~0.07],P=0.10)、Lewinnek安全区内髋臼假体的数量(OR=2.08,95%CI:0.65~6.72,P=0.22)也无统计学差异。同时,DAA具有预防术后脱位的潜在优势,DAA术中使用X线透视会避免出现明显异常的髋臼假体位置。结论:在熟练掌握DAA THA技术的前提下,DAA是具有一定优势的手术入路。Background：The efficacy and safety of direct anterior approach （DAA） for total hip arthroplasty （THA） is still unclear. Objective：To conduct a systematic review and meta-analysis of published studies comparing DAA and posterior ap-proach （PA） for THA. Methods：Controlled trials about comparison between DAA and PA for THA were searched in major databases. Suitable studies were selected according to inclusion and exclusion criteria. The data were extracted and the quali-ty of included studies was evaluated by two reviewers. Meta analysis was conducted using RevMan5.2 software, and the studies that could not be combined were analyzed descriptively. Results：Eleven literatures were included in this study, and a total of 1612 patients were involved. There were 817 patients in DAA group and 795 patients in PA group. All surgeons who performed DAA THA had already completed their learning curves. The patients in DAA group were able to walk earlier without the need for an assistive device than PA group （WMD=-11.05, 95%CI：-17.79,-4.31, P=0.001）, and DAA was su-perior to PA in early postoperative function rehabilitation and activities. There was no statistical difference in the incidences of intraoperative and postoperative complications （OR=1.48, 95%CI：0.69, 3.20, P=0.32）, intraoperative fractures （OR=1.31, 95%CI： 0.50, 3.45, P=0.58）, postoperative dislocations （OR=0.34, 95%CI： 0.09, 1.28, P=0.11）, heterotopic ossification （OR=1.01, 95%CI：0.26, 3.94, P=0.99） or groin pain （OR=2.73, 95%CI：0.62, 12.06, P=0.19） between two groups. Neither were the operative time （WMD=10.25, 95%CI：-6.33, 26.83, P=0.23）, length of hospital stay （WMD=-0.34, 95%CI：-0.76, 0.07, P=0.10） or the percentage of acetabular cups placed within the Lewinnek safe zone （OR=2.08, 95%CI：0.65, 6.72, P=0.22）. DAA could avoid postoperative dislocations as compared with PA and lead to a lower incidence of abnormality in ace-tabular cup position when using intraoperative fluoroscopy during DAA

关 键 词：手术入路 直接前入路 后方入路 全髋关节置换术 

分 类 号：R687.4[医药卫生—骨科学]