直接前入路与后外侧入路全髋关节置换临床疗效的Meta分析

目的 比较经直接前入路(DAA)与后外侧入路(PLA)行全髋关节置换手术的临床疗效。方法 在中国知网数据库、万方数据库、PubMed数据库、Cochrane数据库,以“全髋关节置换”“直接前入路”“后外侧入路”和“direct anterolateral approach”“posterolateral approach”“total hip arthroplasty”为关键词,计算机检索2010年1月—2018年4月国内外已发表关于经DAA与PLA行全髋关节置换术的病例对照研究或随机对照试验的中英文文献,严格评价文献质量,并提取相关数据,运用RevMan 5.3软件对手术时间、术中出血量、住院时间、术后疼痛VAS、术后髋关节功能Harris评分(HHS),以及并发骨折、感染、脱位情况进行Meta分析。结果 纳入14项研究共6 341例患者,其中经DAA手术3 282例,经PLA手术3 059例。3项随机对照试验Cochrane偏倚风险评估均为低风险,11项病例对照研究NOS评分,高质量10项、较高质量1项。Meta分析结果显示,经DAA较PLA 平均手术时间长(WMD=17.26, 95%CI 7.22～27.30, P＜0.05 ),平均术中出血量多(WMD=113.50, 95%CI-1.13～228.14, P=0.05),平均住院时间短(WMD=-0.56, 95%CI -0.94～-0.17, P＜0.05),术后疼痛VAS低(WMD=2.01, 95%CI 0.74～3.28, P＜0.05),术后髋关节功能恢复好(WMD=2.01, 95%CI 0.74～3.28, P＜0.05),差异均有统计学意义;而术后并发骨折(OR=1.25, 95%CI 0.88～1.77, P＞0.05)、感染(OR=0.77, 95%CI 0.21～2.79, P＞0.05)、髋关节脱位(OR=0.68, 95%CI 0.40～1.18, P＞0.05),经DAA和PLA比较差异均无统计学意义。结论 经DAA与PLA行全髋关节置换术均能获得基本满意的临床效果,经DAA手术平均住院时间短,术后疼痛轻,髋关节功能恢复较好;而经PLA手术时间短,术中出血量少。

Direct anterior approach versus posterolateral approach in total hip arthroplasty: a Meta-analysis

Objective To compare the efficacy and safety of direct anterior approach (DAA)with posterolateral approach(PLA)in the treatment of total hip arthroplasty. Methods Reports using case-control studies and randomized clinical trials to compare the DAA with PLA in the treatment of total hip arthroplasty were retried from China National Knowledge Internet, Wanfang Data, PubMed Library, and Cochrane Library, from January 2010 to April 2018. The searched key words were "direct anterior approach""posterolateral approach""total hip arthroplasty". Methodological quality of the trials was critically assessed. Statistical software Revman 5.3 was used for data analysis, and average operation time, average length of hospital stay, VAS, HHS score, average blood loss, fracture post operation, infection, and dislocation of hip joint were analyzed. Results A total of 6 341 patients from 14 articles were included, 3 282 patients using DAA and 3 059 patients using PLA. Three randomized controlled trials were low risk evaluated by Cochrane Collaboration risk of bias assessment tool, and ten cases controlled trials were high quality and one case controlled trial was middle quality evaluated by the Newcastle-Ottawa scale risk of bias assessment tool. The results showed that, when the efficacy, safety of DAA approach and PLA approach were compared in the treatment of total hip arthroplasty, there was statistical significance in the average operation time(WMD=17.26, 95%CI 7.22-27.30, P<0. 05), average blood loss(WMD=113.50, 95%CI-1.13-228.14, P=0.05), average length of hospital stay(WMD=-0.56, 95%CI -0.94--0.17, P<0. 05), VAS post operation(WMD=2.01, 95%CI 0.74-3.28, P<0. 05);HHS score(WMD=2.01, 95%CI0.74-3.28, P<0. 05). However, there was no statistical significance in fracture post operation (OR=1.25, 95%CI 0.88-1.77, P>0.05);infection(OR=0.77, 95%CI 0.21-2.79, P>0.05);dislocation of hip joint (OR=0.68, 95%CI 0.40-1.18, P>0.05). Conclusions Both approaches achieve similar and satisfactory clinical effect in the total hip arthroplasty in the period of follow-up time. The DAA is superior to the PLA in the total hip arthroplasty in regards to the average hospital stay, VAS, HHS. PLA has a shorter operation time and less blood loss.