摘要
目的系统评价微创全髋关节置换术(Mini-THA)的安全性及疗效。方法计算机检索PubMed、OVID数据库、Cochrane图书馆、Elsevier、Springer、维普数据库、中国期刊全文数据库和万方数据库,手工检索6种主要中文骨科期刊及相关参考文献,检索时间自2000-01—2013-06。收集比较Mini-THA与常规THA的随机对照试验(RCT),根据改良Jadad量表评价纳入研究的文献质量,采用RevMan 5.0软件进行Meta分析,比较Mini-THA组和常规THA组的手术切口、手术时间、术中出血量、住院时间、术后Harris评分、假体位置准确度以及并发症发生率。结果共纳入19篇RCT,1 708例。Meta分析结果显示:Mini-THA可显著降低术中平均出血量且切口长度明显短于常规THA。Mini-THA术后Harris评分高于常规THA,数值差异有统计学意义但无临床意义。术后臼杯前倾角方面,常规THA优于Mini-THA,数值差异有统计学意义但无临床意义。在手术时间、术后臼杯外展角、假体安放位置、术中及术后短期并发症、平均住院时间方面两者差异无统计学意义。结论 Mini-THA并不增加手术短期并发症,并且能有效减少首次THA的术中出血量,其短期临床疗效优于常规THA,远期疗效对比有待后续长期随访。
Objective To systematically review the clinical efficacy of unilateral minimally invasive surgery （MIS） versus that of traditional total hip arthroplasty（THA） by recta-analysis. Methods Studies comparing the clinical outcome of THA by MIS and conventional approaches published between January 2000 to June 2013 were searched in the databases of PubMed, OVID EBM,OVID MED- LINE, Cochrane Library, Elsevier, Springer, VIP, CNKI and Wan Fang, supplemented with manual searching of six surgical journals in Chinese as well as relevant references. The methodological quality of included studies was evaluated by the modified Jadad scale. Cochrane RevMan 5.0. software was applied to compare the differences in incision length, operation time, intraoperative blood loss, mean hospital stay, postoperative Harris scores, prosthesis implant accuracy and peri- and postoperative complication rates between two approaches for THA. Restflts Nineteen randomized controlled trials reporting on 1 708 patients were recruited into this study. The recta-analysis showed that： the MIS group showed less blood loss and shorter incision length than those in the conventional approach group. Additionally, significant difference was found in postoperative Harris scores and the cup anteversion between two groups but with little clinical significance, other aspects showed no statistical differences between the two groups. Conclusion The mini-incision group can reduce intraoperative blood loss and incision length. Despite these advantages, the MIS approach shows comparable clinical efficacy as the other in short-term. The long-term efficacy of MIS THA still needs further study.
出处
《中国骨与关节损伤杂志》
2014年第2期117-120,共4页
Chinese Journal of Bone and Joint Injury
基金
南京市医学科技发展项目(YKK12060)
关键词
全髋关节置换术
微创
META分析
Total hip arthroplasty
Minimally invasive
Meta-analysis
