摘要
背景:短柄股骨假体全髋关节置换术(SHA)已经越来越多被应用于髋关节置换中。然而,相对于标准柄股骨假体全髋关节置换术(THA),短柄股骨假体在假体周围骨重建中的优势尚未十分明确。目的:基于随机对照研究的meta分析将THA和SHA术后假体周围骨重建进行比较,旨在为临床医师手术方案的选择提供循证医学证据。方法:从PubMed、Embase、中国知网以及万方数据库中检索有关THA与SHA术后假体周围骨重建的随机对照研究,确定检索时间截点为2018年3月,严格按照纳入标准与排除标准选择符合要求的文献。采用荟萃分析计算加权均数差(WMD)和95%的可信区间(95%CI)。质量评估是由两个独立的研究者使用RveMan5.3软件完成。结果:最终纳入7个随机对照研究,共910位行非骨水泥型全髋关节置换术的患者,5种SHA设计(Proxima, Fitmore, Microplasty short,Unique custom, Omnifit-HA 1017)。集中数据显示,在所有Gruen区中骨密度变化的百分比并没有什么明显的不同:在Gruen1区,WMD=11.33,95%CI:-1.67～24.33,P=0.09;在Gruen7区,WMD=8.46,95%CI:-1.73～18.65,P=0.10。与THA比较,SHA的亚组分析明显说明其Gruen区的骨密度变化更小。在Gruen1区,WMD=27.57,95%CI:18.03～37.12,P<0.0001;在Gruen7区,WMD=18.54,95%CI:8.27～28.81,P<0.0001。结论:SHA术后假体周围骨重建与THA相似。然而,与THA相比,SHA有一定的优势,其优势大小与短柄设计的种类关系密切。另外,尽管全髋关节置换术后假体周围骨重建的模式类似,但是SHA术后假体周围骨重建所累及的股骨长度明显更短。现有的相关文献数量及短柄设计种类有限,未来需要更大规模、多中心、最新设计的SHA的随机对照研究。
Background: Short-stem total hip arthroplasty(SHA) has been increasingly used. However, it is unclear whether there is a superiority of SHA in periprosthetic bone remodeling over standard stem total hip arthroplasty(THA). Objective: To compare the periprosthetic bone remodeling after SHA and THA by meta-analysis of randomized-controlled trials(RCTs), so as to provide evidence-based medical evidence for clinician surgical options. Methods: PubMed, Embase, CNKI and WanFang databases were screened for relevant publications up to March 2018. RCTs that compared periprosthetic bone remodeling with bone mineral density(BMD) changes between SHA and THA were included in this study. Meta-analysis was conducted to calculate weighted mean differences(WMDs) and 95% confidence intervals(CIs) using RevMan 5.3 software. Quality appraisal was performed by two independent reviewers using RevMan 5.3 software. Results: Seven RCTs involving 910 patients and five SHA designs(Proxima, Fitmore, Microplasty short, Unique custom and Omnifit-HA 1017) were selected for meta-analysis.The pooled data showed no significant differences in the percentage of BMD changes in all Gruen zones, with Gruen zone 1(WMD=11.33, 95%CI:-1.67 to 24.33, P=0.09) and Gruen zone 7(WMD=8.46, 95%CI:-1.73 to 18.65, P=0.10). Subgroup analysis of SHA showed a significant less percentage BMD changes compared with THA in Gruen zone 1(WMD=27.57, 95%CI: 18.03 to 37.12, P<0.0001) and Gruen zone 7(WMD=18.54, 95%CI: 8.27 to 28.81, P<0.0001). Conclusions: Periprosthetic bone remodeling in SHA is similar to THA. However, SHA has an advantage over THA and highlights the importance of different SHA designs. Besides, it has to be noticed that despite a similar pattern of periprosthetic bone remodeling, the femoral length where periprosthetic bone remodeling occurs is clearly shorter in SHA. Due to the limited studies and stem designs,large-scale multicenter RCTs including the most recent SHA designs are required.
作者
戴文杰
汤健
闫双根
华兴一
DAI Wenjie;TANG Jian;YAN Shuanggen;HUA Xingyi(Department of Orthopedics,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)
出处
《中华骨与关节外科杂志》
2019年第1期23-29,共7页
Chinese Journal of Bone and Joint Surgery
基金
安徽省科技攻关计划项目(1301042096)
