摘要
目的系统评价非骨水泥型全髋关节置换术(THA)后早期下床并完全负重和晚期下床逐渐负重的安全性和可行性,从而确定术后最佳下床负重时间。方法计算机检索2000—2018年Pubmed、Cochrane Library、EMBase、中国知网、万方、维普、中国生物医学文献等数据库中比较THA术后3 d内下床并完全负重和3 d后下床开始逐渐负重的随机对照试验(RCT),按照Cochrane评价手册5.1推荐的RCT评价工具对纳入文献进行方法学质量评价,提取患者一般资料及深静脉血栓、感染率(肺部或泌尿系统)、术后3个月内Harris评分、术后2年Harris评分、平均住院时间、假体下沉等病史资料,采用Rev Man 5.3软件对这些资料进行Meta分析。结果纳入5个RCT,共246例,其中3 d内下床完全负重组与3 d后下床逐渐负重组均为123例,2组在术后3个月内Harris评分、平均住院时间等方面比较差异有统计学意义(P<0.05),前组较优;在深静脉血栓、感染率、术后2年Harris评分及假体下沉等方面的差异无统计学意义(P>0.05)。结论THA术后3 d内下床并完全负重与3 d后下床逐渐负重相比,可明显提高髋关节近期Harris评分,快速恢复患肢功能,明显缩短住院时间,且未增加术后感染、假体下沉等风险,其安全性和有效性是可靠的。
Objective To evaluate the safety and feasibility of early ambulation with full weight-bearing and late gradual weight-bearing after cementless total hip arthroplasty(THA)systematically,so as to determine the optimal time of postoperative ambulation with weight-bearing.Methods Computerized retrieval was used to compare RCT studies of ambulation with full weight-bearing within 3 days after THA and gradual weight-bearing after 3 days in Pubmed,Cochrane Library,EMBase,CNKI,Wang Fang Data,VIP and CBM databases from 2000 to 2018.The methodological quality of the included literature was evaluated according to the RCT evaluation tools recommended by Cochrane manual 5.1,and the patients’general data were extracted.Other medical history and deep vein thrombosis,infection rate(pulmonary or urinary system),Harris score within 3 months and 2 years,average hospital stay,prosthesis subsidence,etc.were analyzed by RevMan5.3 software.Results Five RCT studies were conducted in 246 patients,including 123 patients getting out of bed with full weight-bearing within 3 days and 123 patients with gradual weight-bearing after 3 days.There were significant differences in Harris score within 3 months after operation and average hospitalization time(P<0.05)between the two groups,superior group was better.There was no significant difference in deep vein thrombosis,infection rate,Harris score 2 years after operation and prosthesis subsidence(P>0.05).Conclusion Compared with getting out of bed with gradual weight-bearing after 3 days,complete weight-bearing within 3 days after THA can improve the short-term Harris score of hip joint effectively,restore the affected limb function quickly,shorten the hospitalization time of patients significantly,and does not increase the risk of postoperative infection,prosthesis subsidence.It’s reliable both in safety and effectiveness.
作者
刘洪文
徐杰
林院
罗奋棋
俞云龙
余博飞
LIU Hong-wen;XU Jie;LIN Yuan;LUO Fen-qi;YU Yun-long;YU Bo-fei(Key Laboratory of Bone Injury and Sports Rehabilitation of Traditional Chinese Medicine,Ministry of Education,Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350100,China;不详)
出处
《中国骨与关节损伤杂志》
2019年第12期1237-1240,共4页
Chinese Journal of Bone and Joint Injury
基金
福建省自然科学基金面上项目(2019J01173)
福建省卫生厅中青年骨干人才项目(2013-ZQN-ZD-1)
