全髋关节置换中前外侧微创入路与后外侧入路疗效差异的Meta分析  

Efficacy of anterolateral minimally invasive approach versus traditional posterolateral approach in total hip arthroplasty: a meta-analysis

作　　者：付攀峰 商炜 亢哲 邓宇[1] 祝少博[1] Fu Panfeng;Shang Wei;Kang Zhe;Deng Yu;Zhu Shaobo(Department of Orthopedic Surgery,Zhongnan Hospital,Wuhan University,Wuhan 430071,Hubei Province,China)

机构地区：[1]武汉大学中南医院骨科,湖北省武汉市430071

出　　处：《中国组织工程研究》2021年第21期3409-3415,共7页Chinese Journal of Tissue Engineering Research

摘　　要：目的:全髋关节置换采用前外侧微创入路相比后外侧常规入路具备某些优势,但其是否具有和后外侧常规入路一样的良好疗效尚存争议。文章应用Meta分析评价前外侧微创入路与后外侧常规入路行全髋关节置换的临床疗效差异。方法:计算机检索英文数据库PubMed、Embase、The Cochrane Library、Web of Science,以及中文数据库中国知网、维普、万方和CBM数据库,检索时间为建库至2020年6月,按照既定纳入排除标准筛选已发表的临床对照研究,严格评价文献质量并提取数据,采用RevMan 5.3软件进行结果数据分析。结果:①共纳入14篇文献,纳入患者1160例,其中包括7项随机对照试验和7项队列研究,均为高质量研究;②Meta分析结果显示,前外侧微创入路比后外侧常规入路切口长度小(MD=-6.61,95%CI:-7.38至-5.84,P<0.00001),术中出血量少(MD=-139.03,95%CI:-169.36至-108.69,P<0.00001),住院时间短(MD=-3.19,95%CI:-4.14至-2.24,P<0.00001),下地时间早(MD=-4.34,95%CI:-4.80至-3.89,P<0.00001),术后各时间点Harris髋关节功能评分高(MD=6.37,95%CI:4.81-7.93,P<0.00001),总并发症发生率低(OR=0.43,95%CI:0.28-0.68,P=0.0003),而手术时间(MD=-1.12,95%CI:-11.03-8.78,P=0.82)与髋关节外展角(MD=0.67,95%CI:-0.22-1.55,P=0.14)无显著差异。结论:前外侧微创入路较后外侧常规入路行全髋关节置换具有更好的效果,能更好地保证手术的安全性和有效性,减少并发症,促进术后髋关节功能恢复,是更具优势的手术入路方式,而更多的评价指标如术后疼痛评分、住院费用和术后髋关节脱位率等尚需未来进一步研究分析验证。OBJECTIVE:Anterolateral minimally invasive approach in total hip arthroplasty has some advantages over traditional posterolateral approach,but whether it has the same good efficacy as poste rolateral approach is still controversial.This article conducted a meta-analysis compa ring clinical outcomes of anterolateral minimally invasive approach and tra ditional poste rolate ral approach for total hip arthroplasty.METHODS:The clinical controlled trials published from inception to June 2020 were sea rched in major databases,including PubMed,Embase,The Cochrane Library,Web of science,CNKI,VIP,Wanfang Data,and CBM.Suitable studies were selected according to inclusion and exclusion crite ria.The quality of included studies was evaluated strictly and the data were extracted.RevMan 5.3 software was used for data analysis.RESULTS:Totally 14 studies(7 randomized controlled trials and 7 cohort studies)were included,with 1160 cases.All studies were evaluated of high quality.(2)Meta-analysis results showed that anterolate ral minimally invasive approach was superior to posterolateral approach in incision length(MD=-6.61,95%CI:-7.38 to-5.84,P<0.00001),intraoperative blood loss(MD=-139.03,95%CI:-169.36 to-108.69,P<0.00001),length of hospital stay(MD=-3.19,95%CI:-4.14 to-2,24,P<0.00001),first weight-bearing time(MD=-4.34,95%CI:-4.80 to-3.89,P<0.00001),Harris hip score(MD=6.37,95%CI:4.81-7.93,P<0.00001)and total complication rate(OR=0.43,95%CI:0.28-0.68),P=0.0003.There was no statistical difference in the operation time(MD=-1.12,95%CI:-1.03-8.78),P=0.82 and the abduction angle of hip joint(MD=0.67,95%CI:-0.22-1.55),P=0.14.CONCLUSION:Anterolateral minimally invasive approach can better ensure the safety and effectiveness of total hip arthroplasty,reduce complications and promote the recovery of hip joint function after surgery.Thus,anterolateral minimally invasive approach is a superior approach which can achieve better effect than poste rolate ral approach.More evaluation indicators such as postoperative pain score,hospital expens

关 键 词：骨 髋 髋关节 关节置换 出血量 并发症 功能 META分析 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学]