多孔钽棒移植与骨移植在髓芯减压保髋术中应用的有效性：Meta分析  

Efficacy of porous tantalum rod implantation versus bone graft transplantation in hip preservation surgery with core decompression: a meta-analysis

作　　者：孔亮 曹向阳 谢颖琼 李薏 张颖 KONG Liang;CAO Xiangyang;XIE Yingqiong;LI Yi;ZHANG Ying(Graduate School,Hunan University of Chinese Medicine,Changsha,Hunan 410208,China)

机构地区：[1]湖南中医药大学研究生院,长沙410208 [2]湖南中医药大学医学院,长沙410208 [3]河南省洛阳正骨医院河南省骨科医院髋部损伤中心,471000 [4]广州中医药大学第二临床医学院,510006

出　　处：《中国骨科临床与基础研究杂志》2019年第3期151-160,共10页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：河南省科技攻关项目（162102310062）;河南省中医药科学研究专项（2018ZYZD02）

摘　　要：目的系统评价多孔钽棒移植与骨移植应用于髓芯减压保髋手术的有效性。方法检索Pubmed、Cochrane Library、Embase、Web of ScienceTM、中国生物医学文摘数据库、中国期刊全文数据库、万方数据库、维普数据库,搜集所有髓芯减压保髋手术中使用多孔钽棒移植和骨移植的随机对照试验和队列研究。两名研究者分别筛选文献、严格评价纳入研究质量并提取数据。采用R软件进行统计分析。结果最终纳入9项随机对照试验、4项前瞻性队列研究和4项回顾性队列研究,共计932例(1011髋)患者。钽棒移植组476例(517髋),骨移植组456例(494髋)。与骨移植组相比,钽棒移植组在术中出血量[MD=–22.24,95%CI(–30.46,–14.02)]、手术时间[MD=–13.67,95%CI(–17.22,–10.12)]、住院时间[MD=–2.53,95%CI(–3.37,–1.69)]、术后Harris评分[MD=7.49,95%CI(5.16,9.82)]等方面具有更优表现(P<0.05);但术后视觉模拟量表评分[MD=–0.92,95%CI(–2.02,0.18)]比较,差异无统计学意义(P>0.05)。结论与骨移植相比较,髓芯减压保髋手术中应用多孔钽棒移植可有效减少术中出血量,缩短手术时间和住院时间,术后髋关节功能恢复更佳,但在患髋疼痛改善方面,两种术式疗效相似。本次Meta分析纳入的研究质量欠佳,未来需要开展大样本、多中心的随机对照研究,为保髋手术的术式选择提供更好的临床证据。Objective To systematically review the efficacy of porous tantalum rod implantation and bone grafting in hip preservation surgery with core decompression.Methods Through a literature search from PubMed,Cochrane Library,Embase,Web of ScienceTM,CBM,CNKI,WANFANG,VIP databases,randomized controlledtrials(RCTs)and cohort studies using porous tantalum rod implantation and bone grafting in hip preserving surgery with core decompression were collected.Two investigators screened the literatures,strictly evaluated the quality of the inclusion study,and extracted the data.R software was used for statistical analysis.Results A total of 9 RCTs,4 prospective cohort studies and 4 retrospective cohort studies were included,with a total of 932 patients 1011 hips(476 patients 517 hips in tantalum rod transplantation group,456 patients 494 hips in bone grafting group).Compared with those in bone grafting group,intraoperative estimate blood loss[MD=-22.24,95%CI(-30.46,-14.02)],operation time[MD=-13.67,95%CI(-17.22,-10.12)],and length of hospital stay[MD=-2.53,95%CI(-3.37,-1.69)],postoperative Harris score[MD=7.49,95%CI(5.16,9.82)]in tantalum rod transplantation group had better performance(P<0.05).However,there was no statistical difference of postoperative visual analogue scale score[MD=-0.92,95%CI(-2.02,0.18),P>0.05)]between two groups.Conclusions The application of porous tantalum rod in hip preservation surgery with core compression,could effectively reduce the intraoperative estimate blood loss,shorten the operation time and length of stay,obtain better postoperative rehabilitation of hip function when compared with bone graft.As for the relief of hip pain,two procedures show similar effects.In this meta analysis,the quality of the included researches is poor.In the future,multicenter and large-sample RCTs should be needed to provide better clinical evidences for the procedure choices of hip preservation surgery.

关 键 词：股骨头坏死 骨移植 钽 保髋手术 髓芯减压 META分析 

分 类 号：R681.8[医药卫生—骨科学] R687[医药卫生—外科学]