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

doi:10.3760/cma.j.issn.2095-7041.2019.02.013

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (3084 KB) HTML (2 KB)
输出: BibTeX | EndNote (RIS)

摘要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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈韬予
	董政权
	王小健
	韩鹏飞
	张芝良
	李鹏翠
	魏垒
	卫小春

关键词 ：关节成形术,置换,髋, 直接前入路, 后外侧入路, Meta分析

Abstract：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.

Key words： Arthroplasty, replacement, hip Direct anterolateral approach Posterolateral Approach Meta analysis

收稿日期: 2018-05-17

基金资助:科技部国家国际科技合作专项项目(2015DFA33050);国家自然科学基金(81601949)

通讯作者: 卫小春, Email: sdeygksys@163.com

引用本文:

陈韬予,董政权,王小健,韩鹏飞,张芝良,李鹏翠,魏垒,卫小春. 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[J]. 中华解剖与临床杂志, 2019, 24(2): 157-164.
Chen Taoyu, Dong Zhengquan, Wang Xiaojian, Han Pengfei, Zhang Zhiliang, Li Pengcui, Wei Lei, Wei Xiaochun. Direct anterior approach versus posterolateral approach in total hip arthroplasty: a Meta-analysis. Chinese Journal of Anatomy and Clinics, 2019, 24(2): 157-164.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2019.02.013 或 http://www.cjac.com.cn/CN/Y2019/V24/I2/157

[1]	曾智敏, 何志勇, 陶崑, 等. 股骨颈骨折内固定失败Ⅱ期行髋关节置换的早期疗效[J]. 中国骨伤, 2013, 26(7): 584-586. DOI:10.3969/j.issn.1003-0034.2013.07.013.
[2]	Hartzband MA. Posterolateral minimal incision for total hip replacement: technique and early results[J]. Orthop Clin North Am, 2004, 35(2): 119-129. DOI:10.1016/S0030-5898(03)00119-6.
[3]	Kwon MS, Kuskowski M, Mulhall KJ, et al. Does surgical approach affect total hip arthroplasty dislocation rates?[J]. Clin Orthop Relat Res, 2006, 447: 34-38. DOI:10.1097/01.blo.0000218746.84494.df.
[4]	Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation[J]. Clin Orthop Relat Res, 2002(405): 46-53.
[5]	Bremer AK, Kalberer F, Pfirrmann CW, et al. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches[J]. J Bone Joint Surg Br, 2011, 93(7): 886-889. DOI:10.1302/0301-620X.9387.25058.
[6]	Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table[J]. Clin Orthop Relat Res, 2005, 441: 115-124. DOI: 10.1097/01.blo.0000194309.70518.cb.
[7]	Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers[J]. J Bone Joint Surg Am, 2011, 93(15): 1392-1398. DOI:10.2106/JBJS.J.00557.
[8]	Zhao HY, Kang PD, Xia YY, et al. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial[J]. J Arthroplasty, 2017, 32(11): 3421-3428. DOI:10.1016/j.arth.2017.05.056.
[9]	Spaans AJ, van den Hout JA, Bolder SB. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach[J]. Acta Orthop, 2012, 83(4): 342-346. DOI:10.3109/17453674.2012.711701.
[10]	Jelsma J, Pijnenburg R, Boons HW, et al. Limited benefits of the direct anterior approach in primary hip arthroplasty: a prospective single centre cohort study[J]. J Orthop, 2016, 14(1): 53-58. DOI: 10.1016/j.jor.2016.10.025.
[11]	Taunton MJ, Mason JB, Odum SM, et al. Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial[J]. J Arthroplasty, 2014, 29(9 Suppl): 169-172. DOI: 10.1016/j.arth.2014.03.051.
[12]	Christensen CP, Jacobs CA. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study[J]. J Arthroplasty, 2015, 30(9 Suppl): 94-97. DOI: 10.1016/j.arth.2014.12.038.
[13]	Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty[J]. J Arthroplasty, 2013, 28(9): 1634-1638. DOI:10.1016/j.arth.2013.01.034.
[14]	Taunton MJ, Trousdale RT, Sierra RJ, et al. John charnley award: randomized clinical trial of direct anterior and miniposterior approach THA: which provides better functional recovery?[J]. Clin Orthop Relat Res, 2018, 476(2): 216-229. DOI:10.1007/s11999.0000000000000112.
[15]	Malek IA, Royce G, Bhatti SU, et al. A comparison between the direct anterior and posterior approaches for total hip arthroplasty: the role of an ‘Enhanced Recovery’ pathway[J]. Bone Joint J, 2016, 98-B(6): 754-760. DOI:10.1302/0301-620X.98B6.36608.
[16]	Maratt JD, Gagnier JJ, Butler PD, et al. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty[J]. J Arthroplasty, 2016, 31(9 Suppl): 127-130. DOI: 10.1016/j.arth.2016.02.071.
[17]	Tripuraneni KR, Munson NR, Archibeck MJ, et al. Acetabular abduction and dislocations in direct anterior vs posterior total hip arthroplasty: a retrospective, matched cohort study[J]. J Arthroplasty, 2016, 31(10): 2299-2302. DOI: 10.1016/j.arth.2016.03.008.
[18]	Newman EA, Holst DC, Bracey DN, et al. Incidence of heterotopic ossification in direct anterior vs posterior approach to total hip arthroplasty: a retrospective radiographic review[J]. Int Orthop, 2016, 40(9): 1967-1973. DOI:10.1007/s00264-015-3048-4.
[19]	Tsukada S, Wakui M. Lower dislocation rate following total hip arthroplasty via direct anterior approach than via posterior approach: five-year-average follow-up results[J]. Open Orthop J, 2015, 9: 157-162. DOI:10.2174/1874325001509010157.
[20]	罗正亮, 陈敏, 尚希福, 等. 侧卧位直接前方入路与后外侧入路全髋关节置换临床疗效比较[J]. 中华医学杂志, 2016, 96(35): 2807-2812. DOI:10.3760/cma.j.issn.0376-2491.2016.35.009.
[21]	赵海燕, 夏亚一, 康鹏德, 等. 直接前入路和后外侧入路全髋关节置换术早期功能康复的比较研究[J]. 中华骨科杂志, 2017, 37(19): 1185-1192. DOI:10.3760/cma.j.issn.0253-2352.2017.19.001.
[22]	Higgins JP, Altman DG, Gtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J]. BMJ, 2011, 343: d5928. DOI: 10.1136/bmj.d5928.
[23]	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605. DOI: 10.1007/s10654-010-9491-z.
[24]	Berend KR, Lombardi AV Jr, Seng BE, et al. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty[J]. J Bone Joint Surg Am, 2009, 91 Suppl 6: 107-120. DOI:10.2106/JBJS.I.00525.
[25]	Ezzet KA, McCauley JC. Use of intraoperative X-rays to optimize component position and leg length during total hip arthroplasty[J]. J Arthroplasty, 2014, 29(3): 580-585. DOI:10.1016/j.arth.2013.08.003.
[26]	Meneghini RM, Pagnano MW, Trousdale RT, et al. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach[J]. Clin Orthop Relat Res, 2006, 453: 293-298. DOI:10.1097/01.blo.0000238859.46615.34.
[27]	Woolson ST, Pouliot MA, Huddleston JI. Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital[J]. J Arthroplasty, 2009, 24(7): 999-1005. DOI:10.1016/j.anh.2009.04.001.
[28]	Ponzio DY, Poultsides LA, Salvatore A, et al. In-hospital morbidity and postoperative revisions after direct anterior vs posterior total hip arthroplasty[J]. J Arthroplasty, 2018, 33(5): 1421-1425.e1. DOI:10.1016/j.arth.2017.11.053.