摘要
目的:评价Super PATH入路和后外侧入路全髋关节置换术(total hip arthroplasty,THA)治疗髋部疾病的临床疗效。方法:应用计算机检索Cochrane Library、Pubmed、Embase、Medline、CBM、CNKI建库至2017年5月国内外公开发表的Super PATH入路(Super PATH入路组)与后外侧入路(后外侧入路组)THA疗效比较的随机对照研究文献或观察性研究文献。由2位研究者独立筛选文献、提取资料,依据Cochrane手册和NOS量表进行文献方法学质量评价后,采用Rev Man5.3软件进行Meta分析。结果:最初检出62篇相关文献,经筛选最终纳入4篇文献,均为中文文献。3篇文献为随机对照研究文献,均未提及具体的随机方法,且均未详细提及应用盲法;1篇为观察性研究文献。纳入的研究对象共266例,Super PATH入路组120例、后外侧入路组146例。Meta分析结果显示,Super PATH入路组的切口长度小于后外侧入路组[SMD=-7.51,95%CI(-8.88,-6.13)]、术后卧床时间比后外侧入路组短[SMD=-3.53,95%CI(-3.98,-3.07)]、住院时间比后外侧入路组短[SMD=-2.54,95%CI(-4.50,-0.59)];2组的手术时间[SMD=0.68,95%CI(-0.17,1.54)]、术中出血量[SMD=-0.17,95%CI(-3.87,3.52)]、术后1个月Harris髋关节功能评分[SMD=0.17,95%CI(-0.29,0.63)]、术后3个月Harris髋关节功能评分[SMD=0.28,95%CI(-0.01,0.56)]、术后3个月双下肢长度差值[SMD=-0.76,95%CI(-3.64,2.11)]、髋臼外展角[SMD=-0.26,95%CI(-0.53,0.01)]、髋臼前倾角[SMD=0.54,95%CI(-0.76,1.84)]比较,组间差异均无统计学意义。利用术后卧床时间及住院时间进行发表偏倚分析,漏斗图显示两侧基本对称。结论:Super PATH入路THA与后外侧入路THA治疗髋部疾病的临床疗效相当,但前者能够显著减少软组织损伤,有利于患者快速康复。
Objective: To evaluate the clinical curative effect of total hip arthroplasty( THA) through supercapsular percutaneously-assisted total hip( Super PATH) approach versus posterolateral approach for treatment of hip diseases. Methods: All the randomized controlled trial( RCT) articles and observational research articles about the curative effect of THA through Super PATH approach( Super PATH approach group) versus posterolateral approach( posterolateral approach group) for treatment of hip diseases that published at home and abroad included from database establishing to May 2017 were retrieved from Cochrane Library,Pubmed,Embase,Medline,CBM and China national knowledge internet through computer. The articles were screened and the information was extracted independently by two searchers. The methodological quality of research in the articles was evaluated according to Cochrane handbook and NOS scale and a Meta-analysis was conducted by using Revman 5. 3 software. Results: Sixty-two articles were searched out in the initial stage. After screening,4 Chinese articles( 266 patients) were included in the final analysis,including 3 RCT articles( in which randomization method and blind method were not mentioned) and 1 observational research article,and 120 patients in Super PATH approach group and 146 patients in posterolateral approach group. The results of Meta-analysis demonstrated that the incision length was less and the postoperative bed rest time and the hospital stay were shorter in Super PATH approach group compared to posterolateral approach group[SMD =-7. 51,95% CI(-8. 88,-6. 13);SMD =-3. 53,95% CI(-3. 98,-3. 07); SMD =-2. 54,95% CI(-4. 50,-0. 59) ]. There were no statistical difference in operative time[SMD = 0. 68,95% CI(-0. 17,1. 54) ],intraoperative blood loss[SMD =-0. 17,95% CI(-3. 87,3. 52) ],Harris hip function scores at 1 month after surgery[SMD = 0. 17,95% CI(-0. 29,0. 63) ],Harris hip function scores at 3 months after surgery[SMD =0. 28,95% CI(-0. 01,0. 56) ],the difference in length between bilateral lower limbs at 3 months after surgery[SMD =-0. 76,95% CI(-3. 64,2. 11) ],acetabular abduction angles[SMD =-0. 26,95% CI(-0. 53,0. 01) ]and acetabular anteversion angles[SMD = 0. 54,95% CI(-0. 76,1. 84) ]between the 2 groups. The result of analysis of publication bias according to postoperative bed rest time and hospital stay showed that the funnel-plot was essentially bilateral symmetry. Conclusion: THA through Super PATH approach and THA through posterolateral approach are similar to each other in the clinical curative effects in treatment of hip diseases,however,the former can significantly reduce the soft-tissue damage and it is beneficial to patient's quick recovery.
出处
《中医正骨》
2018年第1期32-37,40,共7页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
浙江省自然科学基金资助项目(LY14H060001)
浙江省科技计划项目(2017C33227)
浙江省湖州市科学技术局公益性应用研究项目(2016GY26)
关键词
关节成形术
置换
髋
SuperPATH
后外侧入路
META分析
系统评价
arthroplasty
replacement
hip
supercapsular percutaneously-assisted total hip
posterolateral approach
Meta-analysis
sys tematic review
