长期随访下全髋关节置换术采用不同关节界面Meta分析  

Meta-analysis of different joint interfaces in total hip arthroplasty under long-term follow-up

作　　者：吴改革 黄凌岸 郭丽[1] 李鹏翠[1] 卫小春[1] WU Gai-ge;HUANG Ling-an;GUO Li;LI Peng-cui;WEI Xiao-chun(Shanxi Provincial Key Laboratory of Bone and Soft Tissue Injury Repair,Shanxi Medical University,Taiyuan 030001,Shanxi,China)

机构地区：[1]山西医科大学骨与软组织损伤修复山西省重点实验室,山西太原030001

出　　处：《中国骨伤》2023年第2期165-171,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较陶瓷-陶瓷(ceramic on ceramic,CoC)界面与聚乙烯-陶瓷(ceramic on polyethylene,CoP)界面在初次全髋关节置换术中的长期随访效果及并发症,提供临床依据。方法:检索PubMed、EMBase、CoChrane图书馆、Web of science、万方数据库和中国知网,检索时间2000年1月至2021年9月,筛选纳入关于比较陶瓷-陶瓷界面和聚乙烯-陶瓷界面在全髋关节置换长期疗效和并发症的随机对照试验的随机临床研究(randomized controlled trial,RCTs),根据纳入与排除标准进行文献筛选、质量评价及数据提取,采用Review Manager 5.3统计学软件对采用CoC或CoP术后关节功能、翻修、假体骨折、脱位、关节异响及假体磨损率进行统计分析。结果:纳入7个RCTs研究,其中CoC人工关节390髋,CoP人工关节384髋。CoC和CoP人工关节长期关节功能改善相近,差异无统计学意义[MD=0.63,95%CI(-1.81,3.07)],P=0.61;在术后并发症方面CoC人工关节有着较高的关节异响发生率[OR=11.05,95%CI(2.04,59.84)],P=0.005;CoP人工关节则假体磨损速度更快[MD=-87.11,95%CI(-114.40,-59.82)],P<0.0001;关节脱位、假体松动、骨溶解等置换相关并发症和各原因导致的假体翻修率在两组间差异无统计学意义。结论:CoC人工关节的临床功能结果以及并发症与CoP人工关节相当,虽然CoP人工关节假体具有更快的磨损速度,但并不影响关节功能以及增加并发症,且无关节异响。CoC花费大而长期疗效与CoP相当,临床医生选择CoC时应考虑性价比。Objective To compare the long-term follow-up effect and complications of ceramic on ceramic(CoC)interface and ceramic on polyethyleneon ceramic(CoP)interface in primary total hip arthroplasty,and provide clinical evidence.Methods Search PubMed,EMBase,the CoChrane Library databases,Web of science,Wanfang database,and CNKI from January 2000 to September 2021,screening and inclusion of randomized controlled trials(RCTs)comparing the long-term efficacy and complications of CoC interface and CoP interface in total hip arthroplasty.Literature screening,quality evaluation and data extraction were carried out according to the inclusion and exclusion criteria,using Review Manager 5.3 statistical software.The software was used to perform statistical analysis on joint function,revision,prosthesis fracture,abnormal joint noise,and prosthesis wear rate after CoC or CoP.Results Seven RCTs studies were included,including 390 cases of hips with CoC artificial joints and 384 cases of hips with CoP artificial joints.The long-term joint function improvement of CoC and CoP artificial joints was similar and there was no significant differences,with an average difference was MD=0.63,95%CI=(-1.81,3.07),P=0.61.About the postoperative complications,CoC artificial joints have higher incidence rate of abnormal joint noise,with odds ratio(OR)=11.05,95%CI=(2.04,59.84),P=0.005.CoP artificial joints wear faster,with an average MD=-87.11,95%CI=(-114.40,-59.82),P<0.0001.There was no significant difference between the two groups in the replacement-related complications such as joint dislocation,prosthesis loosening,osteolysis,and the rate of prosthesis revision caused by various reasons.Conclusion The clinical function results and complications of CoC artificial joints are comparable to those of CoP artificial joints.Although CoP artificial joint prosthesis has a faster wear rate,it does not affect joint function and increase complications,and there is no abnormal joint noise.CoC is expensive and the long-term efficacy is equivalent to CoP.Clinic

关 键 词：陶瓷 聚乙烯 全髋关节置换 

分 类 号：R459.9[医药卫生—治疗学]