骨水泥与非骨水泥股骨柄在初次全髋关节置换术后疗效的Meta分析

目的：系统评价骨水泥与非骨水泥股骨柄在初次全髋关节置换术后的疗效。方法计算机检索PubMed、EMBASE、OVID、Highwire、SpringerLink、ScienceDirect、Cochrane 图书馆、中国知网、中国生物医学文献数据库文献及手工检索相关文献，收集有关骨水泥与非骨水泥股骨柄在初次全髋关节置换术的随机对照试验，根据考克兰协作组织标准评价纳入试验质量，用Revman5.2软件进行Meta分析。结果纳入11篇文献，共1651例患者，骨水泥髋801例、非骨水泥髋850例。 Meta分析结果示：不限年龄和随访年限，术后翻修率骨水泥固定和非骨水泥固定差异无统计学意义[ OR＝3.20，95％CI （0.72，14.22）， P＞0.05]，5年以内随访术后翻修率两种固定方式差异无统计学意义[OR＝0.41，95％CI （0.15，1.16）， P＞0.05]，5年以上随访术后翻修率骨水泥固定较非水泥固定股骨柄高，差异有统计学意义[OR＝5.92，95％CI （2.68，13.07）， P＜0.01]，术后大腿痛发生率骨水泥固定较非骨水泥固定低，差异有统计学意义[OR＝0.51，95％CI （0.28，0.94）， P＜0.05]，术后Harris评分[MD ＝0.6，95％CI （-0.79，1.99）， P＞0.05]，松动率[OR ＝1.31，95％CI （0.27，6.30）， P＞0.05]、骨折发生率[OR＝0.91，95％CI （0.3，2.7）， P＞0.05]、感染率[OR＝2.46，95％CI （0.7，8.58）， P＞0.05]、异位骨化发生率[OR＝0.91，95％CI （0.63，1.33）， P＞0.05]和脱位率[OR＝3.11，95％CI （0.6，16.10）， P＞0.05]二者差异无统计学差异。结论骨水泥与非骨水泥固定股骨柄在初次全髋关节置换术后均有满意的效果，非骨水泥固定股骨柄5年以上稳定性较骨水泥好，但术后大腿痛的发生率较骨水泥固定柄高。

Meta-analysis of cemented versus uncemented fixation of femoral components in primary total hip arthroplasty

Objective To systematically evaluate all the randomized controlled trails （RCTs） comparing cemented versus uncemented fixation of the femoral components in primary total hip arthroplasty （THA）. Methods All the RCTs related to cemented versus uncemented fixation of the femoral components in the primary total hip arthroplasty were comprehensively searched on Pubmed, EMBASE, OVID, Hihgwire, SpringerLink, ScienceDirect, Cochrane library, China National Knowledge Infrastructure （CNKI） and Chinese BioMedical Literature Database （CBM） from January 1990 to June 2013. Some related articles were hand-searched as well. The methodology quality of the articles was assessed according to the standards recommended by Cochrane Collaboration. Revman 5.2 was applied to the data analysis. Results Eleven RCTs involving 1 651 patients were included. The levels of the included RCTs were very high. The combined results indicated that without considering the patients＇ age and follow-up years, the revision rate of the femoral components was found no difference between the cemented group and the uncemented group [ OR = 3.20, 95% CI （ O. 72, 14. 22 ） , P 〉 0. 05 1. The revision rate showed no statistical difference in the patients of 0 -5 years follow-up [ OR = 0. gl, 95% CI （0. 15,1.16 ）, P 〉0. 051, however the revision rate showed significant difference between the two groups after more than five years follow-up ~ OR = 5.92, 95% CI （2. 68,13.07）, P 〈 0. 011. The postoperative thigh pain occurrence was significantly low in the cemented group [ OR = 0. 51, 95% CI （ O. 28,0. 94 ） , P 〈 0. 05 ] while no statistical difference was noticed in the post-operation Harris Score [ MD = 0. 6, 95 % CI （ - 0. 79,1.99 ） , P 〉 0.05 ], the femoral stem loosening [ OR = 1.31,95 % CI （0. 27,6. 30）, P 〉 0. 05 ], the rate of femoral fracture [OR = 0. 91, 95% CI （0. 3,2. 7 ）, P 〉 0. 05 ], the rate of infection [ OR = 2. 46, 95% CI （0. 7, 8.58 ）, P 〉 0. 051, the rate of heterotopic ossification [