SuperPATH入路与常规入路全髋关节置换手术临床疗效比较的Meta分析
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摘要
目的系统评价SuperPATH入路与传统入路行全髋关节置换的术后临床疗效。方法计算机检索电子数据库PubMed、Embase、The Cochrane library,中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方(WanFang),搜集SuperPATH入路与传统入路的全髋关节置换术疗效对照研究,检索时间均为自建库至2018年3月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,运用RevMan 5.3软件进行Meta分析。结果最终纳入10篇文献,共541例患者。SuperPATH入路行全髋关节置换比传统入路全髋关节置换术中失血量少(WMD=-202.28,95%CI=-266.01～-138.54,P <0.00001),术后6周内及6周后Harris髋关节功能评分均比传统入路高[6周内WMD=8.20,95%CI=6.25～10.15,P <0.00001);6周后(WMD=7.62,95%CI=2.09～13.16,P=0.007)],两组手术时间未见明显差异(WMD=-2.40,95%CI=-7.21～2.42,P=0.33),手术切口长度短于传统入路(WMD=-7.65,95%CI=-8.29～-7.00,P <0.00001)。结论 SuperPATH入路行全髋关节置换术比传统手术入路疗效更有优势,更符合微创理念及术后加速性康复理念。
Objective To explore the postoperative curative effect of SuperPATH approach total hip arthroplasty(THA)comparing with conventional approach THA. Methods Databases including PubMed,Embase,The Cochrane Library,China Biology Medicine(CBM),CNKI and WanFang Data were electronically searched for the published studies on the comparison of curative effect between SuperPATH approach THA and conventional approach THA from the bank establishment to March 2018.Two reviewers independently screened literatures,extracted data and assessed the risk of bias in included studies.Then,a Meta-analysis was performed using RevMan 5.3 software. Results Ten literatures involving 541 patients were included.The results of Meta analysis showed that the intraoperative blood loss of THA via SuperPATH approach was less than that of the conventional approach THA(WMD=-202.28,95%CI =-266.01 to-138.54,P <0.00001).After operation,Both<6 weeks' and>6 weeks' Harris hip joint function score were higher than those of the conventional approach[less than 6 weeks(WMD=8.20,95%CI =6.25 to 10.15,P <0.00001),over 6 weeks(WMD=7.62,95%CI =2.09 to 13.16,P =0.007)].The operative duration of the two groups had no obvious difference(WMD=-2.40,95%CI =-7.21 to 2.42,P =0.33).The length of incision of SuperPATH approach was shorter than that of the conventional approach(WMD=-7.65,95%CI =-8.29 to-7.00,P <0.00001). Conclusion SuperPATH approach THA is more superior to traditional surgical approach THA in curative effect,and more conform to minimally invasive concept and enhanced recovery after surgery concept.
Objective To explore the postoperative curative effect of SuperPATH approach total hip arthroplasty(THA)comparing with conventional approach THA. Methods Databases including PubMed,Embase,The Cochrane Library,China Biology Medicine(CBM),CNKI and WanFang Data were electronically searched for the published studies on the comparison of curative effect between SuperPATH approach THA and conventional approach THA from the bank establishment to March 2018.Two reviewers independently screened literatures,extracted data and assessed the risk of bias in included studies.Then,a Meta-analysis was performed using RevMan 5.3 software. Results Ten literatures involving 541 patients were included.The results of Meta analysis showed that the intraoperative blood loss of THA via SuperPATH approach was less than that of the conventional approach THA(WMD=-202.28,95%CI =-266.01 to-138.54,P <0.00001).After operation,Both<6 weeks' and>6 weeks' Harris hip joint function score were higher than those of the conventional approach[less than 6 weeks(WMD=8.20,95%CI =6.25 to 10.15,P <0.00001),over 6 weeks(WMD=7.62,95%CI =2.09 to 13.16,P =0.007)].The operative duration of the two groups had no obvious difference(WMD=-2.40,95%CI =-7.21 to 2.42,P =0.33).The length of incision of SuperPATH approach was shorter than that of the conventional approach(WMD=-7.65,95%CI =-8.29 to-7.00,P <0.00001). Conclusion SuperPATH approach THA is more superior to traditional surgical approach THA in curative effect,and more conform to minimally invasive concept and enhanced recovery after surgery concept.
引文
[1]张弛.全髋关节换术相关安全性的临床研究[D].郑州:郑州大学,2016.
[2]林作华,黄志伟,黄海波.髋关节置换与内固定治疗老年不稳定型转子间骨折的临床疗效比较[J].右江民族医学院学报,2014,36(3):392-394.
[3] Rosencher N,Kerkkamp HEM,Macheras G,et al.Orthopedic Surgery Transfusion Hemoglobin European Overview(OSTHEO)study:blood management in elective knee and hip arthroplasty in Europe[J].Transfusion,2003,43(4):459-469.
[4]李金泉,黄青松,徐皓,等.SuperPATH和后外侧小切口入路THA治疗股骨头缺血性坏死的近期疗效比较[J].中国骨与关节损伤杂志,2017,32(3):244-247.
[5]任东伟,杨革军,赵华磊,等.SuperPATH切口微创人工全髋关节置换术对股骨头坏死疗效及生活质量的影响[J].河北医科大学学报,2016,37(12):1416-1419.
[6]蔡震海,潘界恩,黄成龙,等.SuperPath微创与常规全髋关节置换术治疗股骨颈骨折的临床疗效比较研究[J].浙江创伤外科,2017,22(2):343-345.
[7]陈剑楼.SuperPATH技术行全髋关节置换的早期效果分析[J].中国卫生标准管理,2017,8(17):36-37.
[8]张建平,梁文楷,赵巍,等.SuperPATH入路与传统后外侧入路髋关节置换疗效对比[J].山西医药杂志,2017,46(22):2726-2728.
[9]袁宏谋,朱佳俊,孙振国,等.SuperPATH入路与后外侧入路行人工全髋关节置换术的疗效比较[J].中国修复重建外科杂志,2018,32(1):14-19.
[10]佟大可,贺倩芸,刘康,等.SuperPATH入路髋关节置换术治疗股骨颈骨折的短期疗效评价[J].中国骨与关节损伤杂志,2017,32(3):308-310.
[11]孙彦平,刘月坤,崔晓亮,等.Superpath全髋置换与全髋关节置换术的疗效、疼痛程度及髋关节功能分析[J].中华骨与关节外科杂志,2017,10(4):305-307.
[12]何启新,乔巨峰,刘永青.SuperPath微创人工全髋关节置换术与常规全髋关节置换术早期疗效比较[J].广东医学院学报,2016,34(3):289-292.
[13]吴良浩,禹宝庆,陈帆成.SuperPATH微创入路人工股骨头置换治疗老年股骨颈骨折:前瞻性、开放性、随机对照临床试验[J].中国组织工程研究,2017,21(7):1009-1014.
[14] Pijls BG,Meessen JM,Schoones JW,et al.Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10Years and Longer Follow-Up:A Systematic Review and Meta-Analysis[J].PloS One,2016,11(6):e0156051.
[15]韦燕华.运动康复安全性评定在老年髋部骨折患者中的应用[J].右江民族医学院学报,2014,36(3):452-453.
[16] Chow J,Penenberg B,Murphy S.Modified micro-superior percutaneously-assisted total hip:early experiences&case reports[J].Current Reviews in Musculoskeletal Medicine,2011,4(3):146-150.
[17] Penenberg BL,Bolling WS,Riley M.Percutaneously assisted total hip arthroplasty(PATH):apreliminary report[J].The Journal of Bone&Joint Surgery.American Volume,2008,90(Suppl 4):209-220.
[18] Rasuli KJ,Gofton W.Percutaneously assisted total hip(PATH)and Supercapsular percutaneously assisted total hip(SuperPATH)arthroplasty:learning curves and early outcomes[J].Annals of Translational Medicine,2015,3(13):179.
[19] Chow J,Fitch DA.In-hospital costs for total hip replacement performed using the supercapsular percutaneouslyassisted total hip replacement surgical technique[J].International Orthopaedics,2017,41(6):1119-1123.
[2]林作华,黄志伟,黄海波.髋关节置换与内固定治疗老年不稳定型转子间骨折的临床疗效比较[J].右江民族医学院学报,2014,36(3):392-394.
[3] Rosencher N,Kerkkamp HEM,Macheras G,et al.Orthopedic Surgery Transfusion Hemoglobin European Overview(OSTHEO)study:blood management in elective knee and hip arthroplasty in Europe[J].Transfusion,2003,43(4):459-469.
[4]李金泉,黄青松,徐皓,等.SuperPATH和后外侧小切口入路THA治疗股骨头缺血性坏死的近期疗效比较[J].中国骨与关节损伤杂志,2017,32(3):244-247.
[5]任东伟,杨革军,赵华磊,等.SuperPATH切口微创人工全髋关节置换术对股骨头坏死疗效及生活质量的影响[J].河北医科大学学报,2016,37(12):1416-1419.
[6]蔡震海,潘界恩,黄成龙,等.SuperPath微创与常规全髋关节置换术治疗股骨颈骨折的临床疗效比较研究[J].浙江创伤外科,2017,22(2):343-345.
[7]陈剑楼.SuperPATH技术行全髋关节置换的早期效果分析[J].中国卫生标准管理,2017,8(17):36-37.
[8]张建平,梁文楷,赵巍,等.SuperPATH入路与传统后外侧入路髋关节置换疗效对比[J].山西医药杂志,2017,46(22):2726-2728.
[9]袁宏谋,朱佳俊,孙振国,等.SuperPATH入路与后外侧入路行人工全髋关节置换术的疗效比较[J].中国修复重建外科杂志,2018,32(1):14-19.
[10]佟大可,贺倩芸,刘康,等.SuperPATH入路髋关节置换术治疗股骨颈骨折的短期疗效评价[J].中国骨与关节损伤杂志,2017,32(3):308-310.
[11]孙彦平,刘月坤,崔晓亮,等.Superpath全髋置换与全髋关节置换术的疗效、疼痛程度及髋关节功能分析[J].中华骨与关节外科杂志,2017,10(4):305-307.
[12]何启新,乔巨峰,刘永青.SuperPath微创人工全髋关节置换术与常规全髋关节置换术早期疗效比较[J].广东医学院学报,2016,34(3):289-292.
[13]吴良浩,禹宝庆,陈帆成.SuperPATH微创入路人工股骨头置换治疗老年股骨颈骨折:前瞻性、开放性、随机对照临床试验[J].中国组织工程研究,2017,21(7):1009-1014.
[14] Pijls BG,Meessen JM,Schoones JW,et al.Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10Years and Longer Follow-Up:A Systematic Review and Meta-Analysis[J].PloS One,2016,11(6):e0156051.
[15]韦燕华.运动康复安全性评定在老年髋部骨折患者中的应用[J].右江民族医学院学报,2014,36(3):452-453.
[16] Chow J,Penenberg B,Murphy S.Modified micro-superior percutaneously-assisted total hip:early experiences&case reports[J].Current Reviews in Musculoskeletal Medicine,2011,4(3):146-150.
[17] Penenberg BL,Bolling WS,Riley M.Percutaneously assisted total hip arthroplasty(PATH):apreliminary report[J].The Journal of Bone&Joint Surgery.American Volume,2008,90(Suppl 4):209-220.
[18] Rasuli KJ,Gofton W.Percutaneously assisted total hip(PATH)and Supercapsular percutaneously assisted total hip(SuperPATH)arthroplasty:learning curves and early outcomes[J].Annals of Translational Medicine,2015,3(13):179.
[19] Chow J,Fitch DA.In-hospital costs for total hip replacement performed using the supercapsular percutaneouslyassisted total hip replacement surgical technique[J].International Orthopaedics,2017,41(6):1119-1123.