微创直接前入路与后外侧小切口入路行初次全髋关节置换术疗效的Meta分析  

Minimally Invasive Direct Anterior Approach and Posterior Lateral Approach for Primary Total Hip Arthroplasty:a Meta-Analysis

作　　者：王磊[1] 董喆[1] 马延辉[1] 呼芳[1] 马改平[1] 王凤凤[2] 张杰[1] WANG Lei;DONG Zhe;MA Yan-hui;HU Fang;MA Gai-ping;WANG Feng-feng;ZHANG Ji＆(a.Department of Trauma Repair Surger;b.Department of Blood Immunology,the Affiliated Hospital of Yah ＇ an University,Yah ＇ an 716000,China)

机构地区：[1]延安大学附属医院创伤修复外科,陕西延安716000 [2]延安大学附属医院血液免疫科,陕西延安716000

出　　处：《实用临床医学（江西）》2018年第7期27-35,共9页Practical Clinical Medicine

摘　　要：目的系统评价微创直接前入路(direct anterior approach,DAA)与后外侧小切口入路(posterior lateral approach,PLA)行初次全髋关节置换术的临床疗效。方法计算机检索Cochrane图书馆、中国生物医学数据库、Pubmed、SCI、Embase、维普信息数据库、万方数据库、中国期刊全文数据库CNKI,收集国内外DAA与PLA行初次全髋关节置换术的文献,检索时限为1966年1月至2017年6月。由两名研究者独立进行文献筛选、资料提取和纳入研究的偏倚风险评价后,提取疗效评价相关指标(手术时间、术中出血量、手术切口长度、住院时间及术后并发症、髋关节HHR评分、髋关节脱位情况),采用RevMan5.2软件进行Meta分析。结果共纳入12个研究,总病例数3877例,其中DAA组2085例,PLA组1792例。经Meta分析,与PLA组比较,DAA组手术时间(SMD=1.74、95%CI:1.08~2.40、P<0.000 01)显著增加,术中出血量(SMD=-2.65、95%CI:-4.18^-1.13、P=0.000 7)、手术切口长度(SMD=-1.83、95%CI:-3.36^-0.30、P=0.02)、住院时间(SMD=-1.54、95%CI:-2.28^-0.80、P<0.000 1)、术后髋关节HHR评分(SMD=0.53、95%CI:0.04~1.01、P=0.03)均显著减少;2组术后并发症、髋关节脱位发生率比较差异均无统计学意义(OR=1.06、0.28,95%CI:0.59~1.92、0.07~1.05,P=0.84、0.06)。结论与后外侧小切口入路相比,微创直接前入路行初次全髋关节置换术在术中出血量、手术切口长度、住院时间、术后髋关节HHR评分方面具有明显优势,但在术后并发症与髋关节脱位发生率方面二者无明显差异。Objective To systematically evaluate clinical efficacy of minimally invasive direct anterior approach（DAA）and posterior lateral approach（PLA）in primary total hip arthroplasty.Methods We searched the Cochranel Library,Pubmed,Embase,SCI,CBMdisc,VIP information,WanFang data and CNKI for the literature published between January 1966 and June 2017 concerning the DAA and PLA for primary total hip arthroplasty.After literature screening,data extraction and bias risk assessment were independently performed by two researchers,operation time,intraoperative blood loss,incision length,hospital stay,postoperative complications,HHR score and hip dislocation were evaluated.The meta-analysis was carried out using RevMan5.2 software.Results A total of 12 studies（3877 cases）were researched,including 2085 cases in DAA group and 1792 cases in PLA group.Compared with PLA,DAA prolonged operation time（SMD=1.74、95%CI：1.08-2.40、P〈0.000 01）,but decreased intraoperative blood loss（SMD =-2.65、95%CI：-4.18--1.13、P=0.000 7）,incision length（SMD =-1.83、95%CI：-3.36--0.30、P=0.02）,hospital stay（SMD =-1.54、95%CI：-2.28--0.80、P〈0.000 1）and postoperative HHR score（SMD =0.53、95%CI：0.04-1.01、P =0.03）.There were no significant differences between the two groups in the incidence of postoperative complications（OR=1.06、0.28,95%CI：0.59-1.92、0.07-1.05,P=0.84、0.06）.Conclusion Compared with PLA,minimally invasive DAA for primary total hip arthroplasty can reduce intraoperative blood loss,incision length,hospital stay and postoperative HHR score.However,there were no differences in the incidence of postoperative complications and hip dislocation between the two approaches.

关 键 词：直接前入路 后外侧小切口入路 全髋关节置换术 临床对照试验 META分析 

分 类 号：R687.4[医药卫生—骨科学]