髋关节置换后双下肢不等长对功能影响的Meta分析

背景：髋关节置换后肢体不等长对功能的影响仍存在不同观点，近年已有一些学者进行了置换后肢体不等长对功能影响的随机对照研究，对这些随机对照研究进行系统评价能更客观地反映情况，为临床工作所借鉴。目的：系统评价全髋关节置换后肢体不等长对功能的影响。方法：计算机检索Cochrane图书馆、Cochrane协作网专业试验数据库、MEDLINE(1950/2010-09)，EMBASE (1979/2010-09)、中国生物医学文献数据库(1978/2010-09)，手工检索中文文献(截至2010-09)，收集所有髋关节置换后双下肢不等长对功能影响的所有随机对照试验或临床对照试验，对其逐个进行方法学质量评价并采用RevMan 5软件进行系统评价。结果与结论：共纳入6篇临床对照试验，包括1 304例患者。其中4篇数据完善，可满足就置换后肢体等长组与非等长组关节功能差异进行Meta分析。结果提示，置换后肢体不等长可影响关节的功能，平衡双下长度，对于减轻跛行步态，提高关节功能有一定临床意义。随时间推移，肢体不等长者的功能障碍有所改善，但与等长者仍存差异。置换后肢体不等长与并发症的发生，诸如脱位、神经损伤、磨损、松动等，由于纳入研究及病例数太少，尚需更多设计严格的研究以增加证据的强度。

Influence of leg length discrepancy following total hip replacement on hip function: A Meta analysis

BACKGROUND: Itremains controversial whether leg length discrepancy (LLD) after hip replacement (THR) affects hip function. Several randomized controlled studies have been conducted to evaluate the influence of length discrepancy on function after hip replacement. System review of these studies could be more objective to evaluate the influence and provide evidence for clinical decision. OBJECTIVE:To assess the influence of LLD on the function of the operated hip after THR. METHODS: Randomized controlled trials and clinical controlled trials of functional evaluation of LLD after THR were identified from Cochrane Back Group, Cochrane Library, additional electronic search (including MEDLINE (1950-2010), EMBASE (1979-2010) and CBM (1978-2010), hand searching for Chinese journals). Two reviewers assessed the quality of the trials and extracted data independently. Meta analysis was conducted using RevMan 5.  RESULTS AND CONCLUSION:A total of 6 clinical controlled trials involving 1 304 patients were included. Four trials with data integrity were reviewed with Meta analysis. LLD after THA can influence the function of hip joints. It is essential to balance the leg length for better outcomes and less limp. Functional disorder in LLD group can be relieved over time, even it was worse than that in non-LLD group. As very few studies and patients were included in the review, further trials with high quality on methodology are needed to identify complications in LLD, such as dislocation, nerve injury, wearing and loosening.