伯明翰髋关节表面置换对比全髋关节置换的效果及金属离子水平：系统评价与Meta分析

文题释义： 全髋关节置换：已被证实是治疗退行性髋关节病的有效方式，并且是治疗老年髋关节病终末阶段的金标准。由于受到假体寿命的影响，对于运动量大的年轻人来说，全髋关节置换并不是此类患者的首选治疗方式，过早置换髋关节可能会导致远期的二次手术。 髋关节表面置换：随着髋关节表面置换假体的不断更新，金属对金属髋关节表面置换，特别是伯明翰髋关节表面置换，已成为全髋关节置换的有效替代方案。由于担心全髋关节置换假体寿命的因素，对于年轻患者而言，伯明翰髋关节表面置换是一种相对更为保守的手术方式。 背景：全髋关节置换是治疗老年髋关节病终末阶段的金标准，但对于运动量大的年轻人来说，伯明翰髋关节表面置换已成为全髋关节置换的有效替代方案。伯明翰髋关节表面置换是否比全髋关节置换有优势尚无定论。 目的：系统评价伯明翰髋关节表面置换对比全髋关节置换临床疗效和金属离子水平。 方法：计算机检索PubMed、EMBASE、the Cochrane library和Web of Science数据库，纳入数据库中所有关于伯明翰髋关节表面置换对比全髋关节置换的临床对照研究，检索年限自各数据库建库至2018-11-30。提取文献资料并进行文献质量评价后，运用RevMan 5.3软件进行Meta分析。 结果与结论：①共纳入12篇符合要求的文献，包括2 317例患者，其中伯明翰髋关节表面置换组1 279例，全髋关节置换组1 038例；②Meta分析结果显示，在主要结局指标上，伯明翰髋关节表面置换组在短期随访中与全髋关节置换组差异无显著性意义RR=0.13，95%CI(0.02，1.01)，P=0.05]，但是在长期随访中伯明翰髋关节表面置换具有更低的翻修率RR=0.27，95%CI(0.15，0.50)，P < 0.000 1]；③在次要结局指标的功能评分上，伯明翰髋关节表面置换组在短期随访的Harris髋关节评分和改良Harris髋关节评分方面优于全髋关节置换组(P < 0.05)；但是在长期随访Harris髋关节评分和加州大学洛杉矶分校评分以及任何时间段的髋关节西安大略和麦克马斯特大学骨关节炎评分方面，2组差异均无显著性意义(P > 0.05)；④最后在金属离子水平中，无论是短期随访还是长期随访，伯明翰髋关节表面置换在钴离子水平方面与全髋关节置换比较差异均无显著性意义(P < 0.05)。而铬离子水平则表明，短期随访中伯明翰髋关节表面置换与全髋关节置换差异无显著性意义(P=0.55)；但是长期随访中发现，伯明翰髋关节表面置换较全髋关节置换释放出更多的铬离子，组间差异有显著性意义(P=0.03)；⑤综上所述，与全髋关节置换相比，伯明翰髋关节表面置换的翻修率和总体并发症更少，髋关节功能更好，铬离子水平更高。此结论仍需要进一步纳入大量大样本、多中心、高质量的随机对照试验加以论证。 ORCID: 0000-0002-5259-5160(范智荣) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Outcomes and metal ion levels of Birmingham hip resurfacing versus total hip arthroplasty: a systematic review and meta-analysis

BACKGROUND: Total hip arthroplasty is the gold standard for the end stage of elderly hip disease, but Birmingham hip resurfacing has become an effective alternative to total hip arthroplasty for young people with high levels of exercise. Whether Birmingham hip resurfacing has an advantage over total hip arthroplasty is still inconclusive. OBJECTIVE: To systematically review the efficacy and metal ion level of Birmingham hip resurfacing and total hip arthroplasty. METHODS: The electronic databases of PubMed, EMBASE, Cochrane library, and Web of Science, which last updated on November 30, 2018, were searched for clinical control study of Birmingham hip resurfacing and total hip arthroplasty. Literature data were extracted and literature quality was evaluated. Meta-analyses were performed with RevMan 5.3 software. RESULTS AND CONCLUSION:(1) Twelve studies were identified with a total of 2 317 patients(n=1 279 in Birmingham hip resurfacing group and n=1 038 in total hip arthroplasty group).(2) Meta-analysis results demonstrated that in the primary outcome measures, the Birmingham hip resurfacing group did not differ from the total hip arthroplasty group during short-term follow-up(RR=0.13, 95% CI 0.02, 1.01], P=0.05), but Birmingham hip resurfacing had a lower revision rate during long-term follow-up(RR=0.27, 95% CI 0.15, 0.50], P < 0.000 1).(3) In the functional scores of secondary outcome measures, the Birmingham hip resurfacing group was superior to total hip arthroplasty in short-term follow-up Harris hip scores and modified Harris hip scores(P < 0.05). However, there was no significant difference between the two groups in the long-term follow-up Harris hip score and University of California, Los Angeles score and the Western Ontario and McMaster University score at any time(P > 0.05).(4) Finally, in the metal ion level, whether it was short-term follow-up or long-term follow-up, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty(P < 0.05). While at the Cr ion level, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty in short-term follow-up(P=0.55), but long-term follow-up showed that Birmingham hip resurfacing released more Cr ions than total hip arthroplasty after surgery, and the difference between the groups was statistically significant(P=0.03).(5) In conclusion, compared with total hip arthroplasty, Birmingham hip resurfacing has a smaller revision rate and overall complication, a better hip function score, but its Cr ion level is higher. This conclusion still needs further a great amount of large-sample, multi-center, high-quality randomized controlled trials to verify its correctness.