系统性红斑狼疮患者全髋关节置换后并发症与髋关节功能恢复的Meta分析  

Meta-analysis of complications and functional recovery of the hip after total hip arthroplasty in patients with systemic lupus erythematosus

作　　者：洪学志 刘雷 姚韵倩 姜玉欣 许佳[1] 莫汉有[1] Hong Xuezhi;Liu Lei;Yao Yunqian;Jiang Yuxin;Xu Jia;Mo Hanyou(Department of Rheumatology,Affiliated Hospital of Guilin Medical College,Guilin 541000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]桂林医学院附属医院风湿免疫科,广西壮族自治区桂林市541000

出　　处：《中国组织工程研究》2021年第27期4415-4420,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81760298),项目负责人:莫汉有;广西自然科学基金项目(2020GXNSFBA297149),项目负责人:洪学志。

摘　　要：目的:随着诊疗技术的发展,系统性红斑狼疮患者生存率明显提高,但伴有慢性并发症如股骨头坏死需要全髋关节置换的患者不断增多。文章对系统性红斑狼疮患者全髋关节置换后并发症与手术前后髋关节功能差异进行系统评价。方法:计算机检索PubMed、中国知网、万方及Cochrane Library数据库中从建库至2020-08-31间发表的系统性红斑狼疮患者行全髋关节置换的文献,采用英国国立临床优化研究所及卡斯尔-渥太华量表进行文献质量评价。收集全髋关节置换后并发症及Harris评分,使用RevMan 5.3软件进行统计分析。结果:①共纳入20篇文献,15项病例系列研究,5项病例对照研究,系统性红斑狼疮患者657例;行全髋关节置换802处,其中最小年龄16岁,平均随访时间53.3个月;②系统性红斑狼疮+全髋关节置换患者术后共出现235次并发症,前5位分别为输血52次(22.1%),深静脉血栓21次(8.9%),切口感染18次(7.7%),假体脱位17次(7.2%),伤口血肿16次(6.8%),与对照组比较,系统性红斑狼疮+全髋关节置换患者发生并发症风险明显增加(P<0.001);③系统性红斑狼疮+全髋关节置换患者Harris平均评分从术前的43.7分提高到最后随访的89.5分;④Meta分析结果显示,系统性红斑狼疮+全髋关节置换患者术后Harris评分高于术前(MD=45.73,95%CI:42.0-49.4,P<0.01),系统性红斑狼疮+全髋关节置换与非系统性红斑狼疮+全髋关节置换后患者Harris评分比较差异无显著性意义(MD=-0.84,95%CI:-2.1-0.41,P=0.19)。结论:系统性红斑狼疮+全髋关节置换患者术后主要并发症为出血、深静脉血栓及切口感染,术后髋关节功能较术前明显改善,因此认为全髋关节置换可作为系统性红斑狼疮合并晚期股骨头缺血性坏死患者手术治疗选择,但未来仍需大样本、前瞻性临床研究验证。OBJECTIVE:With the development of diagnosis and treatment technology,the survival rate of patients with systemic lupus erythematosus is significantly improved,resulting in an increasing number of patients with chronic complications such as osteonecrosis of the femoral head requiring total hip arthroplasty.This article systematically evaluated the complications of total hip arthroplasty in patients with systemic lupus erythematosus and compared the Harris score before and after operation.METHODS:A computer search of PubMed,CNKI,Wanfang and Cochrane Library databases published from the inception of the database to August 31,2020 for patients with systemic lupus erythematosus who underwent total hip arthroplasty was conducted.The literature quality was evaluated by the National Institute for Clinical excellence and Castle-Ottawa scale.Postoperative complications and Harris score after total hip arthroplasty were collected.RevMan 5.3 software was used for statistical analysis.RESULTS:(1)A total of 20 articles were included,with 15 series studies and 5 control studies,containing 657 patients with systemic lupus erythematosus.Total hip arthroplasty was performed in 802 places,with the youngest age being 16 years old;average follow-up time was 53.3 months.(2)There were 235 complications after systemic lupus erythematosus+total hip arthroplasty.The top 5 included blood transfusion 52 times(22.1%),deep venous thrombosis 21 times(8.9%),wound infection 18 times(7.7%),prosthesis dislocation 17 times(7.2%)and wound hematoma 16 times(6.8%).Compared with the control group,the risk of complications in systemic lupus erythematosus+total hip arthroplasty patients significantly increased(P<0.001).(3)The mean Harris score increased from 43.7 preoperatively to 89.5 at last follow-up in systemic lupus erythematosus+total hip arthroplasty patients.(4)Meta-analysis results showed that Harris score was higher after operation than that before operation in systemic lupus erythematosus+total hip arthroplasty patients(MD=45.73,95%CI:42.0-49.

关 键 词：关节 髋 系统性红斑狼疮 关节置换 并发症 股骨头坏死 髋关节功能 META分析 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]